This research aims to examine the effect of the local government's elderly social assistance program on out-of-pocket (OOP) health spending for the poor elderly group in Indonesia. The data used is Susenas data March 2020 using counterfactual analysis. What is meant by counterfactual in the context of this research is to compare the actual condition of OOP health spending for the elderly when receiving interventions from local government elderly social assistance and without receiving intervention. Because the requirement to be able to carry out a counterfactual analysis is that the subjects of the study must have the same/balanced characteristics, the data used is limited to the elderly in the bottom 40 percent of the economic group. Moreover, the randomization technique is also carried out using the Propensity Score Matching-Nearest-Neighbors (PSM-NN) method, namely constructing data that has similar characteristics into two groups: the group that received treatment and the group that did not receive treatment. The results of this study indicate that the poor elderly group who receive elderly social assistance from the local government has a higher OOP health spending of 26.6 percent compared to the poor elderly group who do not receive assistance. The high spending on OOP was mainly due to an increase in spending on curative.