Determinants of rural-urban differential in healthcare utilization among the elderly population in India

Abstract

Background Population aging poses a demographic burden on a country such as India with inadequate social security systems and very low public investment in health sector. This challenge of accelerated demographic transition is coupled by the rural-urban disparity in access to healthcare services among the elderly people in India. An important objective of India’s National Health Policy (2017) is to “progressively achieve universal health coverage” which is posited upon mitigating the sub-national disparity that necessitates identifying the drivers of the disparity for targeted policy intervention. This study, therefore, makes an attempt towards the exploration of the prominent contributory factors behind the rural-urban gap in utilisation of healthcare among the older population in India. Methods The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0) of the 75th round of the National sample Survey conducted during July 2017–June 2018. Two binary logistic models have been proposed to capture the crude and the adjusted association between health seeking behaviour and place of residence (rural/ urban). To compute the group differences (between rural and urban) in the rate of healthcare utilization among the elderly population in India and to decompose these differences into the major contributing factors, Fairlie’s decomposition method has been employed. Results The logistic regression models established a strong association between place of residence and likelihood of healthcare utilisation among the Indian elderly people. The results of the Fairlie’s decomposition analysis revealed considerable rural-urban inequality disfavouring the rural residents and health care utilisation was found to be 7 percentage points higher among the older population residing in urban India than their rural counterparts. Level of education and economic status, both of which are indicators of a person’s Socio-Economic Status, were the two major determinants of the existing rural-urban differential in healthcare utilisation, together explaining 41% of the existing rural-urban differential. Conclusion Public health care provisions need to be strengthened both in terms of quality and outreach by way of greater public investments in the health sector and by building advanced health infrastructure in the rural areas. Implementation of poverty alleviation programmes and ensuring social-security of the elderly are also indispensable in bringing about equity in healthcare utilisation.

Changing demography and the challenge of dementia in India

“…India’s diverse landscape can be visualized in two broad categories 93 . Urban India consists of the urban poor (including migrant workers from villages), who generally have low levels of literacy, and the middle class, who generally have high levels of literacy and better access to health-care services 94 . Rural India consists of a predominantly agriculture-dependent population living in villages and hailing from a lower socio-economic background than the urban Indian population.…”

The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019

“…However, this study findings showed that sick rural adults were less likely than their urban counterparts to seek healthcare from a healthcare practitioner. While most studies from other countries have identified socio-cultural norms as determinants, distance and proximity to a healthcare facility also was identified as a significant factor for this behavior [ 65 , 66 , 67 , 68 ]. Within the public sector, the distribution of healthcare facilities and resources heavily favored urban areas [ 20 , 25 , 26 , 27 , 28 , 29 , 31 ].…”

“…Furthermore, the current study found that a larger percentage of people in rural areas fall into the lower income quintiles. Inadequate access to health care and a lack of income are two reported factors that contribute to the rural population’s poor health [ 65 , 66 , 67 , 68 ]. As the majority of Malaysians with low socioeconomic status came from rural areas [ 69 ], this calls for more efforts to promote healthcare utilization and enhance accessibility in the remote and rural areas.…”

Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India

“…Literature showed a higher concentration of unmet needs in healthcare among the rural and poor households. 3,8,15,[31][32][33][34][35]38,63 Various factors such as availability of infrastructure, level of access, utilisation, treatment seeking behaviour, and ability to pay were cited to be responsible for this widening gap. 25,35,38,40 Studies revealed higher reporting for various ailments in the urban areas which were better equipped with the prevention and management strategies.…”