Transportation Barriers on Healthcare Utilization among Elderly Population Living in Mahasarakham Province, Thailand

Abstract

Background: Health Insurance System Research Office (HISRO) of Thailand found that the utilization of healthcare services of outpatient care was decreasing from 2009 to 2010 among elderly. Transportation could be a predominant factor influencing outpatient care utilization especially in rural area where patients must travel long distances to access health care services. This study aimed to assess the association between healthcare utilization and transportation barriers and perception among elderly in Mahasarakham province Thailand.

Method: A cross-sectional study design was applied in Muang district and Wapi Pathum district in Mahasarakham province. Face-to-face interview by health volunteers was utilized to obtain information from 359 elderlies using structured questionnaire, which 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 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 reported non-utilize the healthcare service even though they preferred to receive care.  We found that traveling duration and distance from home to healthcare services were significantly influenced on healthcare utilization of elderly in health promoting hospital and provincial hospital care (p-value<0.05). Elderly out-of-pocket of transportation expenses was significantly associated with utilization of 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).

Conclusion: Travel duration and distance from elderly home to healthcare services was associated with healthcare utilization in health promoting hospital and provincial hospital. Elderly satisfaction and perception on ability to pay for transportation expense was related to their healthcare utilization. Further basic insurance strategy may consider to partially support transportation expenses for elderly to lessen their ability to pay perception.