Role of pension and insurance schemes in healthcare utilisation and catastrophic health expenditure among rural elderly in Bengaluru

Background : Financial vulnerability is a major barrier to healthcare access among the rural elderly in India. Pension and government insurance schemes aim to improve financial risk protection, yet their influence on healthcare utilisation and catastrophic health expenditure remains uncertain. Objectives : To estimate the coverage of pension and insurance schemes among the rural elderly, assess their association with healthcare utilisation and catastrophic health expenditure, and explore stakeholder perspectives on accessibility and effectiveness. Methodology : This study adopted a convergent parallel mixed-methods design, in which quantitative and qualitative data were collected concurrently, analysed separately and integrated during interpretation to enable triangulation of findings. It was conducted from December 2024 to February 2025 in six rural villages of Bengaluru. One hundred elderly individuals aged ≥60 years attending geriatric outreach clinics were recruited using convenience sampling. In-depth interviews with local stakeholders were analysed thematically to explore contextual barriers to scheme utilisation. Associations were assessed using Fisher’s exact test and logistic regression to estimate adjusted odds ratios. Results : Fifty-six percent of participants received old age pensions and 31% had health insurance coverage. Twenty-five percent experienced catastrophic health expenditure. Pension receipt was associated with higher regular healthcare utilisation (OR 3.0, p = 0.089). In adjusted analysis, pension receipt was associated with lower odds of catastrophic expenditure (AOR 0.42, 95% CI 0.16–1.06), whereas insurance coverage showed higher odds (AOR 2.19, 95% CI 0.84–5.73); neither was statistically significant. Qualitative interviews highlighted irregular pension disbursement, documentation barriers and limited awareness of scheme entitlements. Conclusion : Pension receipt showed a trend towards improved healthcare utilisation and reduced financial hardship, while insurance coverage did not demonstrate significant protection against catastrophic expenditure. Strengthening benefit coverage and implementation mechanisms may enhance financial risk protection for rural elderly populations.