Public-private healthcare utilisation and satisfaction among older adults with palliative care needs in India: a study based on Longitudinal Ageing Study in India

BACKGROUND: Strengthening health systems to accommodate the growing need for palliative care is a global priority. Currently, one in eight older adults in India requires palliative care with complex healthcare needs. The interaction of older adults with these needs with public and private healthcare providers is unknown. This study aims to determine the patterns of public and private healthcare utilisation and their disparities among older adults with palliative care needs. METHODOLOGY: A cross-sectional study design was employed using the Wave-1 data of the LASI. Using the SPICT-LIS, 2903 older adults with palliative care needs were identified for the analysis. The primary outcome variable, i.e. the utilisation of the type of health facilities for outpatient visits and hospitalisation, was summarised as descriptive statistics. The Chi-square and Kruskal-Wallis tests were employed to identify the association between background characteristics and the utilisation of different facilities. Additionally, multivariate logistic regression (Odds Ratio) was performed to determine the factors associated with utilisation of private facilities. RESULTS: The utilisation of private facilities (60.3%) was higher than that of public facilities (23%) and other facilities (16.6%) for outpatient care. Similarly, hospitalisation in private health facilities was the highest (58.3%), followed by public (39.7%) and other facilities (1.9%). Disparities in the utilisation of private facilities based on wealth status, caste, food insecurities and geographical regions were observed for both outpatient care and hospitalisation. A higher level of satisfaction with private facilities compared to public health facilities was observed in terms of waiting time, being treated respectfully, providing clear explanations, maintaining privacy during conversations, and cleanliness. CONCLUSION: Older adults with palliative care needs used private healthcare facilities significantly more than public ones for outpatient care and hospitalisation. Their use of private facilities was also linked to disparities based on socio-economic status. Addressing gaps in public health service provisions is crucial to achieving universal health coverage for older adults with palliative care needs. Public-private partnerships, social welfare schemes, and expanded health insurance could help reduce these disparities.