Determinants of healthcare utilisation among elderly attending selected public hospitals in Peninsular Malaysia

Abstract

Population ageing is a significant demographic event in the 21st century. This phenomenon is driven by a demographic transition, which consists of a shift from high fertility and high mortality rates to lower fertility and lower mortality rates. The growing number of the elderly in Malaysia poses new challenges to the government, as this will impact the national development, both economically and socially. Several works of literatures that are related to healthcare utilisation are available, however, the psychological aspects and the level of health literacy that influence the healthcare utilisation are hardly focused upon, specifically in Malaysia. Thus, there is a lack of empirical evidence in the study area that needs to be linked. Moreover, there is yet no comprehensive model of healthcare utilisation in the current literature. Realising the need to closely examine the determinants of elderly healthcare utilisation, this research aims to identify the determinants of healthcare utilisation among the elderly in Malaysia. A positivist explanatory approach was used to explore the relationships between variables. The data collection was carried out for a period of two months. An administered questionnaire that consisted of seven sections measuring demographic data, need for care, attitude towards ageing, health literacy, healthcare utilisation, self-perceived health status, and patient satisfaction, were used to collect data. Four hundred and seventy-seven (n=477) elderly outpatients attending outpatient department in 14 hospitals were recruited. Sample were selected using non-probability, convenience sampling. The SPSS Statistics version 23.0 was used for data analysis. Findings suggested that age, ethnicity, education level, income level, need for care, attitude towards ageing and health literacy were associated with healthcare utilisation. Hierarchical multiple regression was conducted to identify the predictors of healthcare utilisation. The findings from this analysis indicate that education level, income, need for care and attitude towards ageing of the elderly were significant factors that predict healthcare utilisation. Finally, mediation analysis was computed to test the mediating effect of health literacy on age and healthcare utilisation and education level and healthcare utilisation. Findings reveal that health literacy was found to give a significant mediating effect between age and education level with healthcare utilisation. This research provides further insight into determinants of healthcare utilisation on the elderly in Malaysia. The major theoretical contributions of the study include extending the previous literature on healthcare utilisation. From the practical viewpoint, the findings have provided evidence for the healthcare provider and policy makers to better understand factors that influence healthcare utilisation among the elderly in Malaysia. However, the study is subjected to several limitations. The approach of this research was deductive in nature, which begins with a theory, developing hypotheses from that theory, and then collecting and analysing data to test those hypotheses, which limits the researcher’s understanding of what is really happening, or what is perceived to happen in the health care setting. Hence, future efforts should be placed on examining the determinants of healthcare utilisation among the elderly from qualitative perspectives.