Page 77 - IJPS-11-2

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

Although this study proposes specific recommendations chronic diseases, which, as indicated in previous studies,
based on the key findings above, these recommendations are significantly related to access to health care. The
constitute short-term measures. In the long term, the National Statistical Office of Thailand should consider this
government should continue to improve the shortage of issue in future HWSs. Finally, a longitudinal study should
health-care infrastructure and resources, a well-known be performed to evaluate how the cross-sectional effect of
factor that hampers access to health care (Antos, 2007; living arrangements on UHN found in this study changes
Paek et al., 2016). over time.

Finally, this study has several limitations that should be 5. Conclusion
addressed in future studies. First, the PSM method used in
this study should be improved by including more diverse The present study examined UHN among older people
factors (e.g., disability status and geriatric factors such living alone in Thailand using the national 2019 HWS
as an activity of daily living index) that are more directly dataset. This study had two specific objectives. The first
related to access to health care to further alleviate selection was to analyze the impact of living alone on UHN using
bias and more precisely evaluate the impact of living alone a matched sample obtained from a PSM method. The
on UHN. The HWS dataset and other data sources, such second objective was to analyze the sociodemographic
as the National Survey of Older Persons in Thailand, will determinants of UHN using the entire sample of data. The
need to be merged for this purpose. findings related to the first objective indicate that older
Second, in this study, UHN was measured using self- people living alone experienced 1.613 (CI: 1.066 – 2.440)
reported data, with respondents directed to assess their times more UHN than those living with others. The
needs for health care based on their personal perceptions. findings regarding the second objective reveal that older
Thus, they should be aware of their health-care needs people with low incomes and chronic diseases experienced
and willing to report them. Such subjective measures 1.39 (CI: 1.015 – 1.923) and 5.63 (CI: 4.375 – 7.243) times
inevitably include issues of limited recall and social more UHN than their counterparts.
desirability biases. Objective measures of UHN (e.g., Non-medical costs and a lack of social support
UHN adjusted for objective health outcomes evaluated facilitating access to health-care (e.g., a lack of caretakers
by health professionals) can be employed in the future as to bring older people to health-care providers and a lack
alternative or complementary measures to improve the of affordable transportation options) may have been the
issues associated with subjective UHN (Howe Hasanali, primary causes of the high rate of UHN for these groups, as
2015; Newacheck et al., 2000). indicated in previous studies. Thus, the government should
Third, the simplistic categorization of living continue its efforts to alleviate these issues. Specifically,
arrangements (living alone versus not living alone) used the existing CHV program should prioritize older people
in this study should be further subdivided and analyzed in living alone who need caretakers during illness. Local
future studies. The initial plan of this study was to divide health authorities should support the program by offering
living arrangements into three categories: living alone, health emergency vehicles, especially for those living
living with a spouse, and living with a spouse and adult outside major cities with limited transportation options to
children. However, because of the relatively small number access health-care providers.
of older people living alone in the HWS dataset, the PSM The government should also increase the OAA to
method cannot provide stable matched pairs. enhance older people’s financial independence and
This issue also occurred when measuring the extend current telemedicine services to district hospitals
independent and control variables. For instance, and community health centers; such measures have been
subdivided income (such as quintile and quartile income) found to improve health-care access for low-income
and age did not allow the PSM to offer stable marched pairs. older people who do not have extra resources to travel
Furthermore, regarding chronic diseases, the HWS dataset to health-care providers and chronically ill older people
designated 32 diseases (e.g., diabetes, hypertension, and who need health care regularly in Thailand. Although this
cancer) as chronic diseases. We initially categorized the study proposes specific recommendations based on the
chronic diseases according to their severity. However, this main findings above, these recommendations represent
does not allow the PSM method to offer stable matched short-term measures. In the long term, the government
pairs. In addition, because the HWS required respondents should continue to resolve the shortage of health-care
to select only their primary chronic disease, we could infrastructure and resources, which are well-known factors
not classify chronic patients according to the number of hampering access to health care.

Volume 11 Issue 2 (2025) 71 https://doi.org/10.36922/ijps.1218