TRANSPORTATION BARRIERS ON HEALTHCARE UTILIZATION AMONG ELDERLY POPULATION LIVING IN MAHASARAKHAM PROVINCE THAILAND

Abstract

Background: The recent study by Thailand Health Insurance System Research Office (HISRO) in 2009 and 2010 showed that utilization of healthcare services of outpatient care was decreased among elderly. Transportation may be a predominant factor influencing outpatient care utilization especially in rural area where patients must travel long distances to access health care services. Therefore, this study aimed to find an association between the healthcare utilization of elderly and their living in urban/rural area and to access an association between healthcare utilization and transportation barriers and perception among elderly in Mahasarakham province Thailand. Method: A cross-sectional study was conducted in Muang district (urban) and Wapi Pathum district (rural) in Mahasarakham province. Face-to-face interview by health volunteers was utilized to obtain information from 359 elderly using structured questionnaire (179 elderlies in urban area and 180 elderlies in rural area). Briefly, questionnaire was divided into 3 parts; demographic characteristic, transportation barriers and perception of transportation to healthcare services. Bivariate analysis using Chi-square and independent t-test was performed to investigate the association. Results: Majority of respondents in this study was female (59.3%) and had average age (±SD) of 70(±7.1) years old. Sixty-six percent of them reported insufficient monthly income. More than half of them had underlying disease (53.5%) and moderate health status (56.5%). During the past two months, sixty-eight percent of overall elderly (72.6 % of elderly in urban area and 63.3 % of elderly in rural area) reported non-utilize the healthcare service even though they preferred to seek for care. However, statistical significance of an association between urban/rural area and healthcare utilization was not achieved (p-value=0.06). Considering on transportation barriers, this study found that traveling duration and distance from home to healthcare services were significantly influenced on healthcare utilization of elderly in primary and secondary care (p-value<0.05). Elderly out-of-pocket of transportation expenses was significantly associated with utilization of secondary care (provincial hospital) (p-value = 0.02). Their perception on ability to pay for transportation expenses was significant different between elderly who had visited and who had not visited healthcare services (p-value = 0.05). Conclusions: Travel duration and distance from elderly home to healthcare services was associated with healthcare utilization in primary and secondary care. Elderly satisfaction and perception on ability to pay for transportation expense was related to their healthcare utilization. An elderly healthcare utilization promoting strategy should be recognized to enhance elderlies’ health. Further basic insurance; universal healthcare coverage, strategy may consider to partially support transportation expenses for elderly to lessen their ability to pay perception.