This study aims to assess healthcare utilisation and financial protection among the elderly in different states of India, which are at different demographic and epidemiological transition levels (ETLs). Unit-level data from India’s 75th Round National Sample Survey, 2017–2018, was used in the study. In India, 27.7% of the elderly reported acute or chronic ailments in the last 15 days, whereas 8.5% had been hospitalised in the last 365 days. Unmet healthcare needs were lower in urban (OR: 0.49 (95% CI: 0.41–0.59); p < .001) areas compared to rural areas. Disease burden was higher in high ETL states of India compared to low ETL states. The private sector was the major service provider for outpatient and inpatient care. However, public healthcare utilisation was higher in southern and northeastern states and union territories as compared to other parts of India. Out-of-pocket and catastrophic health expenditures were significantly higher in the private sector than in the public sector. The overall disease burden and unmet healthcare needs of the elderly vary in different states of India. There is an urgent need for government-led efforts to improve health systems and social care policies, which should be state-appropriate.
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