Exploring reasons for non-utilization of healthcare services among older adults with non-communicable diseases in India: evidence from a nationally representative study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20260766Keywords:
Healthcare utilization, India, Non-communicable diseases, Older adults, Treatment gapAbstract
Background: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality among Indian older adults, accounting for over two-thirds of the national disease burden. Despite increased access to healthcare, disparities in utilization and treatment-seeking behaviour remain. This study explores the reasons for non-utilization of healthcare services among older adults with NCDs.
Methods: This study used 2,598 samples aged 60 and above who reported major reasons for not-visiting healthcare facilities despite their disease diagnosis, from the Longitudinal Ageing Study in India (LASI) wave-1, a nationally representative dataset. The self-reported reasons for non-utilization of healthcare services were used as the dependent variable. Bivariate analysis and multinomial logistic regression were employed to examine the association between non-utilization of healthcare service and NCDs, while socio-demographic and economic characteristics were used as covariates in the analysis.
Results: The most cited reasons for not seeking care were illness not serious (41.3%), followed by having medicine at home (32.3%), and financial and work constraints (13.7). Regression results revealed that the elderly with cancer (RRR 47.54), stroke (RRR 8.28), arthritis (RRR 3.46), and lung disease (RRR 2.37) were more likely to report low treatment effectiveness, while psychological issues were more frequently reported reasons due to financial/work constraints (RRR 3.03), and family/other constraints (RRR 4.29) significantly.
Conclusions: The findings highlight the reliance on private facilities and the non-utilization of disease-specific healthcare among the elderly. Policies should prioritize financial protection, decentralized chronic care, and interventions to address socioeconomic inequalities, thereby advancing health coverage for India’s ageing population.
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References
Arokiasamy P. India’s escalating burden of non-communicable diseases. Lancet Glob Health. 2018;6(12):e1262-3.
World Health Organization. Noncommunicable Diseases Country Profiles 2018. World Health Organization. 2018. Available from: https://www.who.int/publications/i/item/ncd-country-profiles-2018. Accessed on 6 March 2026.
Arokiasamy P, Uttamacharya U, Jain K, Biritwum RB, Yawson AE, Wu F, et al. The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal? BMC Med. 2015;13(1):178. DOI: https://doi.org/10.1186/s12916-015-0402-8
Chauhan S, Kumar S, Patel R, Simon DJ, Kumari A. Burden of communicable and non-communicable diseases-related inequalities among older adults in India: a study based on LASI survey. BMC Geriatr. 2022;22(1):790. DOI: https://doi.org/10.1186/s12877-022-03481-x
Zaidi I, Sharma T, Chaudhary S, Alam A, Anjum S, Vardha J. Barriers to access healthcare among the elderly population in rural regions of India. Int J Community Med Public Health. 2023;10(11):4480-4. DOI: https://doi.org/10.18203/2394-6040.ijcmph20233498
Bhagyalakshmi C, Kodali P. Utilization of noncommunicable disease services provided by public health facilities in Kasaragod, Kerala. Arch Med Health Sci. 2019;7(1):18. DOI: https://doi.org/10.4103/amhs.amhs_132_18
Banerjee S. Determinants of rural-urban differential in healthcare utilization among the elderly population in India. BMC Public Health. 2021;21(1):939. DOI: https://doi.org/10.1186/s12889-021-10773-1
Frumence G, Nyamhanga T, Anaeli A. Facilitators and barriers to health care access among the elderly in Tanzania: a health system perspective from managers and service providers. J Aging Res Healthcare. 2017;1(3):1-10. DOI: https://doi.org/10.14302/issn.2474-7785.jarh-16-1354
Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilization for common mental disorders: a systematic review. BMC Psychiatr. 2018;18(1):262. DOI: https://doi.org/10.1186/s12888-018-1837-1
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196. DOI: https://doi.org/10.1016/S2214-109X(18)30386-3
Henriquez-Camacho C, Losa J, Miranda JJ, Cheyne NE. Addressing healthy aging populations in developing countries: unlocking the opportunity of eHealth and mHealth. Emerg Themes Epidemiol. 2014;11(1):136. DOI: https://doi.org/10.1186/s12982-014-0021-4
Vaishnav LM, Joshi SH, Joshi AU, Mehendale AM. The National Programme for Health Care of the Elderly: A Review of its Achievements and Challenges in India. Ann Geriatr Med Res. 2022;26(3):183. DOI: https://doi.org/10.4235/agmr.22.0062
Msyamboza KP, Ngwira B, Dzowela T, Mvula C, Kathyola D, Harries AD, et al. The burden of selected chronic non-communicable diseases and their risk factors in Malawi: nationwide STEPS survey. PLoS One. 2011;6(5). DOI: https://doi.org/10.1371/journal.pone.0020316
Mohanty SK, Sahoo U, Rashmi R. Old-age dependency and catastrophic health expenditure: evidence from longitudinal ageing study in India. Int J Health Plann Manage. 2022;37(6):3148-71. DOI: https://doi.org/10.1002/hpm.3546
Khura B, Mohanty P, Patnaik L, Pradhan KB, Khubchandani J, Padhi BK. Socioeconomic inequalities in the prevalence of non-communicable diseases among older adults in India. Geriatrics. 2022;7(6):137. DOI: https://doi.org/10.3390/geriatrics7060137
Arokiasamy P. India’s escalating burden of non-communicable diseases. Lancet Glob Health. 2018;6(12):e1262-3. DOI: https://doi.org/10.1016/S2214-109X(18)30448-0
Sahoo H, Govil D, James KS, Prasad RD. Health issues, health care utilization and health care expenditure among elderly in India: thematic review of literature. Aging Health Res. 2021;1(2):100012. DOI: https://doi.org/10.1016/j.ahr.2021.100012
Kumar V. Health status and health care services among older persons in India. Aging India Perspect Prosp Policies. 2013;67-84.
Kanungo S, Bhowmik K, Mahapatra T, Mahapatra S, Bhadra UK, Sarkar K. Perceived morbidity, healthcare-seeking behavior and their determinants in a poor-resource setting: observation from India. PLoS One. 2015;10(5):1-21. DOI: https://doi.org/10.1371/journal.pone.0125865
Elias MA, Pati MK, Aivalli P, Srinath B, Munegowda C, Shroff ZC, et al. Preparedness for delivering noncommunicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India. BMJ Glob Health. 2017;2. DOI: https://doi.org/10.1136/bmjgh-2017-000519
Pati MK, Swaroop N, Kar A, Aggarwal P, Jayanna K, Van Damme W. A narrative review of gaps in the provision of integrated care for noncommunicable diseases in India. Public Health Rev. 2020;41(1):8. DOI: https://doi.org/10.1186/s40985-020-00128-3
Pati MK, Bhojani U, Elias MA, Srinivas PN. Improving access to medicines for non-communicable diseases in rural primary care: results from a quasi-randomized cluster trial in a district in South India. BMC Health Serv Res. 2021;21(1):770. DOI: https://doi.org/10.1186/s12913-021-06800-x
Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan. 2012;27(4):288-300. DOI: https://doi.org/10.1093/heapol/czr038
Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, et al. Action to address the household economic burden of non-communicable diseases. Lancet. 2018;391(10134):2047-58. DOI: https://doi.org/10.1016/S0140-6736(18)30323-4
Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, et al. Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. Am J Public Health. 2016;106(4):e3. DOI: https://doi.org/10.2105/AJPH.2015.302987
IIPS, NPHCE, MoHFW. Longitudinal Ageing Study in India (LASI) Wave 1, 2017-18, India. IIPS; 2021. Report. Available from: https://www.iipsindia.ac.in/ content/lasi-publications. Accessed on 6 March 2026.
Gupta R. Rural-urban divide in mental health care in India: bridging the gaps. Indian J Soc Psychiatr. 2024;40(1):7-10. DOI: https://doi.org/10.4103/ijsp.ijsp_41_24
Bango M, Ghosh S. Social and regional disparities in utilization of maternal and child healthcare services in India: a study of the post-national health mission period. Front Pediatr. 2022;10. DOI: https://doi.org/10.3389/fped.2022.895033
Kastor A, Mohanty SK. Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing? PLoS One. 2018;13(5):e0196106. DOI: https://doi.org/10.1371/journal.pone.0196106
Panagioti M, Skevington SM, Hann M, Howells K, Blakemore A, Reeves D, et al. Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice. Qual Life Res. 2018;27(5):1257-68. DOI: https://doi.org/10.1007/s11136-017-1775-2
Gupta S, Virk A, Mittal A, Agarwal BK. Patterns and determinants of healthcare-seeking behavior among hypertensive patients in a rural population of north India: a mixed-method study. J Fam Med Prim Care. 2020;9(6):2830. DOI: https://doi.org/10.4103/jfmpc.jfmpc_200_20
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