Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India.

Hypertension is one of the most prevalent NCDs in the world. Its prevalence is especially high among the elderly, a demographic group on the rise in low and middle income countries. Extant medical literature calls for early detection to prevent aggravation of problems when old. In this paper, we investigate whether diagnosis of hypertension among adults aged 45 and above, is correlated with geographic access to primary public healthcare services, after accounting for a rich set of potentially confounding covariates. Our study focuses on rural India where access to public primary health services is especially poor but hypertension rates are high. Using the first wave of the Longitudinal Ageing Survey of India (LASI) 2017-19, we find that hypertensive adults belonging to poor households, face a distance cost of public primary health facilities and are 8 percent less likely to be aware of their hypertension when Primary Health Centres are 10 km away. Since almost 10 percent of villages in India are at least 10 km away from PHCs, this exclusionary effect is significant. Our analysis suggests that even though public primary facilities are poorly staffed and managed in India, and private care is popular, geographical expansion of public primary facilities can still play an active role in NCDs and public primary health financing should take heed of the need for such expansion.