Study underscores health care access concerns for elderly
Older adults in the country travel an average distance of 43.62km for hospitalisation and 14.54km for outpatient care, according to a recent study that highlights how physical distance adversely impacts overall health care delivery and health-seeking behaviours.
In addition, nearly two thirds (67%) of the older adults in urban India availed themselves of outpatient care within 10km as opposed to 28.3km for people in rural and remote areas, displaying a significant urban-rural disparity.
Older adults are defined as individuals above the age of 60.
The authors said this disparity grew disproportionately for in-patient care where the distance and time taken were two times higher for rural sexagenarian than their urban counterparts. 'For in-patient admission, 95% arranged their own mode of transport, while 5% used ambulance services, with no significant urban-rural difference,' the study said.
The study titled 'Miles to go before I seek: distance to the health facility and health care use among older adults in India' has been published in The Lancet Regional Health-Southeast Asia.
The authors used the nationally representative Longitudinal Ageing Study of India (LASI) (Wave-1, 2017-18) consisting of 31,902 older adults' data to analyse the average distance travelled by older adults for their routine and acute health care needs.
According to the paper, India is home to 138 million older adults, and is witnessing a rapid demographic transition, with the proportion of the population aged 60 and above increasing from 7.4% in 2001 to a projected 13.2% in 2031.
Nearly half of these people have multiple long-term or debilitating conditions that demands continuous and coordinated health care.
'…the complexity of health care requirements increases as individuals age, necessitating frequent and urgent medical attention. However, access to such care is often restricted by factors such as the availability of local health services, financial constraints, low health literacy, and inadequate family or social support systems…,' said the authors in the paper.
Both out-patient and in-patient care utilisation was high (73% and 40% respectively) when the distance was within 10km. However, with an increase in distance, a commensurate decline in the out-patient utilisation was observed, being 17% and 10% for facilities at a distance of 11-30km and 30km or more respectively, said the paper. Additionally, for women, those living alone, and with low education and income, this decline was more pronounced. Around 19% of rural older adults had to travel at least 60km to avail in-patient care. The situation was similar for urban dwellers with 10% travelling at least 60km for in-patient care.
Among states, Tripura (80.4%), Manipur (70.4%), and Kerala (59%) had more inpatient visits within 0-10km. While in Kerala, the authors attribute it to easy access and better availability of health infrastructure, in Manipur and Tripura, they said, it may be because people rely on nearby facilities during emergency inpatient situations.
'Potential geographical challenges are also evident in hilly states like Nagaland (0%), Sikkim (17.6%), and Himachal Pradesh (4.5%) which show fewer inpatient visits within 0-10 km. Moreover, higher percentages of inpatient visits at distances over 61km in the state of Mizoram (51%), Nagaland (21.5%), and Himachal Pradesh (38.5%), indicating poor and limited accessibility to nearby health facilities. The majority outpatient visits are within 0-10km in most states, with the highest in Tripura (87.9%), Kerala (83.7%) and Manipur (78.4%).'
Uttar Pradesh, Bihar, and Madhya Pradesh show moderate proximity (11-60km) for outpatient care but higher share of inpatient visits at distances beyond 30km. The less variability in distance among southern states indicates well-distributed health care infrastructure, they said.
'Our analysis demonstrated significant variations in health facility distance and the implied travel burden among older adults. Longer travel time and farther facility act as a potential barrier for receiving timely and essential health care for this population which could posit higher risk of adverse outcomes,' they added.
As a potential solution, authors suggest addressing transportation barriers.
'Various studies have shown that interventions aimed at minimising transportation barriers among low-income, remote and older population not only improves access to medical care but patient outcome as well, while being cost-efficient,' they said.
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