Health system responsiveness to older adults with functional limitations and socio-economic vulnerability in India

BACKGROUND: Health system responsiveness (HSR) is a core health system goal yet remains underexamined for older adults with functional limitations and socio-economic vulnerability in India. OBJECTIVE: To present a novel assessment of HSR among older adults aged 60+ with functional limitations and socio-economic vulnerability in India across six domains: prompt attention, dignity, communication, confidentiality, choice of providers, and quality of amenities. METHODS: We analysed data from the nationally representative Longitudinal Ageing Study in India Wave 1 (2017-2018), including 16,659 older adults for outpatient care and 2,358 for inpatient care. Multivariable linear regressions assessed the association between HSR and functional limitations, multimorbidity, and socio-economic factors. Functional limitations were defined as one or more limitations in Activities of Daily Living and/or Instrumental Activities of Daily Living. Overall HSR score was calculated by summing across domains. RESULTS: Median HSR score was 24 (range 6-30), equivalent to approximately 75 on a 0-100 scale, for outpatient and inpatient care. Older adults with functional limitations experienced poorer responsiveness in outpatient (β = -0.62; 95%CI: -0.84, -0.41) and inpatient care (β = -0.62; 95%CI: -1.14, -0.09). Negative associations were observed in public facilities, while in private facilities this was significant only for outpatient care. Among those with functional limitations, lower castes and lower economic status reported poorer responsiveness. CONCLUSIONS: Older adults with functional limitations in India experience poorer HSR, with worse care among lower castes and poorer groups. These findings suggest the presence of ableism within the Indian health system that needs to be systematically identified and tackled to ensure equitable and responsive healthcare.