Page 76 - IJPS-11-2

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

the second objective was to analyze the sociodemographic entire sample of data (Table 3) shows that older people
determinants of UHN using the entire sample of data. with a low income and chronic disease encountered 1.391
The results related to the first objective indicate that (CI: 1.015 – 1.923) and 5.629 (CI: 4.375 – 7.243) times
living alone has a positive effect on UHN. The BLR model more UHN than their counterparts.
using the matched sample (Table 2) shows that older people The lack of affordable transportation options for older
living alone experienced 1.613 (CI: 1.066 – 2.440) times people with low incomes may be a significant reason for
more UHN than those not living alone. This result indicates the UHN, as indicated in previous studies (Kullanit &
that living alone could significantly increase the probability Taneepanichskul, 2017; Srisatidnarakul & Bunthumporn,
that older people will experience UHN, regardless of 2020). The old-age allowance (OAA) universal pension for
differences in sociodemographic characteristics. people aged 60 years or older is the main source of income
This finding is consistent with previous studies for most older people in Thailand. Some low-income people
in Thailand (Meemon & Paek, 2020; Osornprasop & depend on OAA as their only source of income. These low-
Sondergaard, 2016). Furthermore, this study’s use of a income individuals usually spend their entire monthly
PSM method to adjust for potential sociodemographic allowance on room rent and food and, therefore, do not
confounders provided a precise estimate of the relationship have extra resources to travel to health-care providers.
between living arrangements and UHN, which could Public transportation (e.g., public buses and taxis), which
improve the existing knowledge about the health-care is relatively affordable, is available only in Bangkok (the
accessibility of older people living alone in Thailand. capital city of Thailand) and neighboring major cities.
Older people living outside these major cities must rent
The unavailability of caretakers may have been the
primary cause of the high rate of UHN among older people private vehicles to access health-care providers. However,
living alone, as indicated in previous studies (Meemon & renting private vehicles is not affordable for many older
Paek, 2019; Osornprasop & Sondergaard, 2016). In general, adults, especially those with low incomes (Osornprasop &
Sondergaard, 2016).
access to health care significantly decreases for older
people because the decline in physical function, which is a Thus, in addition to our previous recommendation
common feature of older people, makes it difficult for them for vehicle support from local health authorities, the
to travel independently to health-care providers (Sibbritt government should improve financial independence to
et al., 2007). In Thailand, family members often serve as alleviate the UHN of low-income older people. According
caretakers, ensuring health-care access for older people to a simulation analysis performed by Meemon & Paek
(Rattanamongkolgul et al., 2012; Thanakwang et al., 2014). (2020), when the present OAA of 600 – 1,000 baht
However, this family support is limited for older people (equivalent to 18 – 30 USD) increased to 3,500 baht
living alone compared to those living with family members, (equivalent to 105 USD), the probability of encountering
which may increase the probability that older people living UHN decreased significantly, which should be considered
alone will experience UHN. by the government.
To address this issue, the government should strengthen In addition, the high rate of UHN among older people
the existing community health volunteer (CHV) programs. with chronic diseases is likely attributed to their increased
As a formal part of Thailand’s primary health-care system, frequency of visits to health-care providers, potentially
CHVs have been connecting community members with resulting in an increased probability of experiencing
mobility limitations (e.g., people with disabilities and UHN than those without chronic diseases. Telemedicine
bedridden patients) and health-care providers (Kowitt can be a measure to improve access to health care for older
et al., 2015). The CHV program should also prioritize people who need regular health care, such as those with
older people living alone who need caretakers during chronic or congenital diseases. In Thailand, telemedicine
illness. Local health authorities should assist with the services have been implemented in major central-level
CHV program by offering health emergency vehicles, hospitals since the COVID-19 pandemic in 2020 and
particularly for older people who live outside major cities have been reported to substantially increase health-care
and have limited transportation options to access health- accessibility, particularly for chronic patients (National
care providers. Health Security Office, 2020). Therefore, the government
Regarding the second objective, the results revealed should extend telemedicine services to district-level
that inequality in access to health care among older people hospitals and community-level health centers to alleviate
exists based on their income and whether they have a the high rate of UHN among older people with chronic
chronic disease. Specifically, the BLR model using the diseases.

Volume 11 Issue 2 (2025) 70 https://doi.org/10.36922/ijps.1218