Page 71 - IJPS-11-2

International Journal of
Population Studies Health-care access for the elderly living alone

(World Bank, 2023). This percentage is expected to grow social support, family members can act as a “convoy” that
to approximately 27% by 2040 (United Nations, 2022), helps older family members cope with life challenges by
indicating that one in every four Thai people will be older providing economic and non-economic support, such as
in less than two decades. care during illness and transportation support for health-
Along with the rapid increase in the older population, care access. According to this model, co-residence with
the number of older people living alone is also increasing. the family is one of the most important social structures
A recent study using national survey data showed that supporting older people (Antonucci & Akiyama, 1987; Li
approximately 13.3% of the older population lived alone in et al., 2018; Samanta et al., 2015).
2017 (Meemon & Paek, 2020), which was almost four times This view is particularly evident in developing
higher than the 3.6% reported in 1994 (National Statistical countries, including Thailand, that have underdeveloped
Office of Thailand, 2018). The estimate of 3.6% was based social welfare systems for older people. In these countries,
on an age range of 60 years and above; thus, the actual families are the main source of economic and non-economic
increase in the percentage of older people living alone support to ensure that the day-to-day needs of older people
would be far higher than four times, given the increased are met (Kamiya & Hertog, 2020; Rattanamongkolgul
minimum age of 65 years. et al., 2012; Samanta et al., 2015; Thanakwang et al., 2014).
One of the social challenges related to the increase in the Thus, considering the increasing number of older people
older population is ensuring adequate health-care access living alone in Thailand, it is crucial to evaluate the effect of
for this group, as they have greater health-care demands living arrangements on health-care access in this group to
than younger generations but fewer economic and social develop a policy that provides them with adequate access
resources to meet these demands (Meemon & Paek, 2019). to health care.
Thailand has provided almost free health care for the entire 1.1. Literature review
population since universal health coverage began in 2002.
Previous longitudinal studies have indicated that access to Although access to health care and its influencing factors
health care (e.g., outpatient visits and inpatient admissions among older people have been extensively studied
from public health-care providers) has significantly in Thailand, the issue of health-care access for older
increased after the introduction of universal health individuals living alone has received less attention.
coverage. Furthermore, the increase was significantly Two studies analyzed the relationship between living
higher among people with low socioeconomic status, arrangements and health-care access among older adults
such as low-income and older people (Gruber et al., 2014; in Thailand (Osornprasop & Paek, 2020; Osornprasop
Health Insurance System Research Office, 2012; Meemon & Sondergaard, 2016). These studies showed that older
& Paek, 2018). people living alone have a lower socioeconomic status and
less access to health care than those not living alone.
Nevertheless, socioeconomic inequalities in health-
care access have been consistently found in previous Specifically, Meemon & Paek (2020) reported that older
cross-sectional studies. Multiple previous studies have people living alone were observed to be older, female, and
indicated that access to health care has been significantly more likely to have a lower income, education level, and a
lower among older people than among younger people higher prevalence of chronic diseases compared to those
(Chongthawonsatid, 2021; Meemon & Paek, 2019; who do not live alone. Approximately 40% of older people
Thammatacharee et al., 2021) and socioeconomically living alone live below the national poverty line. This
unequal among older people (Meemon & Paek, 2019; percentage was approximately three times lower for older
Osornprasop & Sondergaard, 2016). Moreover, other adults who did not live alone. In terms of access to health
studies have identified that non-medical costs and a lack care, the prevalence of unmet health-care needs (UHN),
of social support facilitating access to health care (e.g., a which is a situation in which individuals need health care
lack of caretakers to bring older people to health-care but cannot access it, was around 4% among older people
providers and a lack of affordable transportation options) living alone. This prevalence was approximately two times
are the main reasons for older people’ poor health-care higher than among those who did not live alone. Moreover,
access (Kullanit & Taneepanichskul, 2017; Srisatidnarakul low-income and chronic diseases were positively associated
& Bunthumporn, 2020). with UHN.

These findings raise concerns about health-care access This subject has also been investigated in many previous
for older people living alone, who probably lack the studies in other countries. Contrary to the findings from
resources needed to access health care that can be acquired Thailand, those from other countries show that older
from family members. According to the convoy model of people living alone use health-care services – based on,

Volume 11 Issue 2 (2025) 65 https://doi.org/10.36922/ijps.1218