The world is ageing with unprecedented momentum, and large global south nations are ageing at higher speed than their northern peers. They have grown old while they have not grown rich, straining their health systems' ability to deliver financial protection. This work aimed to assess whether Indonesia's health insurance scheme, seven years on, has delivered equal protection for families with older members (over 60 years) as for other families. Methods Before-and-after observation study is designed to estimate how much difference the Scheme made to probabilities of catastrophic payment and financial impoverishment for the two family types. As in recent assessments, two national socioeconomic surveys were used (2013, 2021). Two level observations came from 622,125 families residing in 514 districts across the archipelago. Financial protection indicators against catastrophic payment and impoverishment were constructed following recent works. I estimated two level probit models, then plotted marginal probabilities of financial protection. A sensitivity analysis was conducted with the standard financial protection indicator. Findings After the Scheme, financial hardship for all family types has reduced by 19%. But families with older members (compared to other families) have an additional 0.7% risk of incurring catastrophic payment or financial impoverishment. And social and spatial inequalities in health persist. Discussion While the Scheme has markedly improved financial protection for all, families with older members remain at higher risk of being unprotected. The global south can prepare for an ageing world by monitoring financial protection and its social determinants and systematically distinguishing families with older members.

The authors have declared no competing interest.

This study did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study uses data available to the public from the Central Bureau of Statistics Indonesia. https://sirusa.bps.go.id

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

This study uses data available to the public from the Central Bureau of Statistics Indonesia. https://sirusa.bps.go.id

https://sirusa.bps.go.id