Senior citizens in India grapple with long distances to health facilities, study finds
Even within a universal healthcare system, there continue to remain marked disparities in access to care among older adults, with distance to healthcare facility posing a critical barrier, said a study published in The Lancet Regional Health Southeast Asia titled 'Miles to go before I seek: distance to the health facility and health care use among older adults in India'. It further noted that ensuring availability of health services within reach and reducing geographical barriers are paramount towards ensuring an equitable and inclusive healthcare system where no one is left behind.
The study points out that while a lot of research has explored financial constraints and health literacy as barriers to healthcare access, there is limited evidence on how physical distance impacts healthcare utilisation and health-seeking behaviours in older adults in India. For this paper, researchers 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 healthcare needs and concomitant healthcare utilisation through an equity lens.
Distances travelled
In India, access to healthcare is often restricted by factors including availability of local health services, financial constraints, low health literacy, and inadequate family or social support systems. India, home to 138 million older adults, 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 populations have multiple long-term or debilitating conditions that demand continuous and coordinated health care.
The study notes that older adults, on an average, travelled a distance of 14.54 km to seek outpatient services and 43.62 km for inpatient care respectively. For two-thirds (67%) of urban older adults, the availed outpatient facility was within 10 km of reach, while for their rural counterparts, it was 28.3 km, revealing a significant urban-rural disparity. This grew disproportionately for in-patient care, where the distance and time taken was two times higher for rural sexagenarians compared to their urban counterparts. For in-patient admission, 95 per cent arranged their own mode of transport, while 5 per cent used ambulance services, with no significant urban-rural difference.
Further both out-patient and in-patient care utilisation was high (73% and 40% respectively) when the facility distance was within 10 km. As the distance increased, a commensurate decline in the out-patient utilisation was observed, being 17% and 10% for facilities at 11–30 km and 30 km or more respectively. Additionally, for women, those living alone, and those with low education and income, this decline was more pronounced. Around 19% of rural older adults had to travel at least 60 km to avail of in-patient care. The situation was similar for urban dwellers with 10% travelling at least 60 km for in-patient care.
Risk of adverse outcomes
Long travel times and distant facilities act as a potential barrier to receiving timely and essential healthcare for this population which could posit high risk of adverse outcomes, warned the study adding that addressing transportation barriers could be a key strategy to improve access to care among the geriatric population, especially those residing in rural areas.
'Various studies have shown that interventions aimed at minimising transportation barriers among low-income, remote and older populations not only improves access to medical care but patient outcome as well, while being cost-efficient. Future research must develop and demonstrate how community-based transport service can be embedded within as a model for implementation for geriatric care. Given the rising number of ageing populations who are home-bound, a shift from clinic-based out-patient care to home-based primary care merits consideration through a mix of mobile medical van, digital healthcare and inclusive social support,'' recommends the study.
It adds that there is a need to design and formulate strategies on how existing Ayushman Arogya Mandir (community-based primary care centres) can be strengthened to meet the comprehensive healthcare needs of growing geriatric population.
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