Healthcare utilisation, routine healthcare follow-up, and financial burden among older adults with chronic illness in western India

Background: Population ageing in India is accompanied by a rising burden of chronic diseases, requiring regular healthcare utilisation among older adults. However, evidence suggests that healthcare utilisation remains suboptimal due to structural, financial, and informational barriers. Methods: This secondary cross-sectional analysis used data from a parent study conducted among 380 older adults with chronic illnesses residing in selected rural and urban communities of western India. Data were collected using a pre-tested semi-structured questionnaire. Healthcare utilisation patterns, out-of-pocket expenditure (OOPE), and access-related factors were assessed. Results: Private healthcare facilities accounted for the majority of initial diagnoses 277(72.9%). Routine healthcare follow-up was reported by 233 (61.3%) participants, with no significant rural-urban difference (p = 0.92). Among participants reporting routine healthcare follow-up, private healthcare facilities were the most commonly used source of follow-up care (118/233; 50.6%). Nearly one-third (29.5%) had changed healthcare providers, more commonly in urban areas (35.8% vs. 23.2%; p = 0.007), primarily due to distance (50.9%) and cost (21.4%). A substantial proportion incurred OOPE for healthcare visits (69.2%) and medicines (77.1%). OOPE was associated with lower odds of routine healthcare follow-up compared with those receiving free care (AOR = 0.18; 95% CI: 0.09–0.35; p < 0.001). Conclusion: Healthcare utilisation among older adults remains suboptimal, with substantial reliance on private healthcare and a high financial burden. Strengthening accessible primary healthcare, improving access to affordable medicines, and expanding financial protection mechanisms may support continuity of care among older adults in similar resource-constrained settings.