The present study aims to explain the relationship between marital status and inpatient health service among the elderly in India and suggests that elderly widowed women are more dependent on the inpatient health service than elderly married women. Even after adjusting predisposing, enabling, and need factors under the health behavioural framework given by Andersen, there is no substantial change in the association between marital status and inpatient health service for women. However, the present study does not find evidence of such associations for men.
With the death of the spouse, the elderly widowed women face certain disadvantages that reflect in the social role, access to resources, and social and economic dependency [28–30]. Moreover, widowed women experience structural alienation from her parental family and changes in the family ties [16, 31]. With the extended duration in the widowhood status, there is a reflection of poor physical health and subjective health among widowed women in India [15, 24]. A certain change in marital status also has a replicative effect on health services utilisation [14]. The study finds that a change in marital status can critically affect the use of inpatient health care services among older women. The widowhood among elderly women pushes them to access inpatient health services. Previous studies have reported, widowed women reluctant to report the initial health problem to household members and they try to be more productive even after their poor health which ultimately leads to severe health problem and admitting in hospitals [16, 18].
In contrast, as in most parts of India, the patriarchal nature of society still prevails. There is not much difference in the social role, privileges of men in access to the resource as compared to women [29, 31]. Thus, the use of the inpatient health care service has not appeared to be typically affected by the widowhood status for men. Unlike the female counterpart, the access to resources of men irrespective of their marital status empowers them to avail of physical and medical care in the households. Therefore, perhaps access to the inpatient health care facilities is lower among the male as compared to the female counterpart.
Along with marital status, under Andersen's health behaviour framework predisposing factors like age, household size; enabling factors like MPCE, economic dependency, and need factors like having chronic ailment, perceived poor health and physical immobility explain part of differential usage of inpatient health service among older women. Along with education, the result is also similar to men. Age is found to be the most significant predictor for poor health and access to the impatient health care services. The previous studies also documented that the older elderly are more dependent on inpatient health services use than the younger elderly [32–34]. Since the life expectancy of women is higher than men in India, it may pose the women a higher risk of ailments and resultant hospitalisation. The studies have reported that household size is associated with the access to inpatient health care services [35–37]. Our findings also indicate that elderly in small family utilise more inpatient health services than the household with big family size. Perhaps, the small family size limits the number of persons available for taking care of the elderly in the home, which may increase the likelihood of hospitalisation.
The individuals who have better access to knowledge and resources are more likely to use the health care services appropriately than those who have limited knowledge and resources [38, 39]. In our study, we found that educated elderly irrespective of marital status use higher inpatient health care services than uneducated older adults [38]. At the same time, economic status emerges as one of the most significant expiating factors for the utilisation of inpatient health care services. Previous studies also suggested that the elderly with higher monthly per capita consumption expenditure have more access to health care services than their counterpart [39, 40]. In the line of our findings, the earlier study also found that the elderly with poor physical and subjective health are more likely to use inpatient health services as compared to their opposite groups [41]. Similarly, if the physical immobility increases, the likelihood of accessing inpatient health care services increases among the elderly [42, 43].
The findings from present study are consistent with the prior studies in Taiwan and India [14, 44]. In the light of marital protection hypothesis, we find found that widowhood and the use of inpatient healthcare services has a strong association for women and there is inconsistency in such association for men [1–3, 44, 46]. However, the mechanism may be different as the social & cultural norms, and the economic aspects are mostly different from many high-income countries. Nevertheless, despite controlling factors under the Andersen's health behaviour framework, widowhood among the women come to be the strong explanatory factor for utilisation of the inpatient health care service for women.
The study has a number of limitations. Firstly, in our study, we only considered married, and widowhood status despite the fact that the separation and divorce cases are increasing and possibly have a different consequence on access to health care services. Secondly, the present study only focuses on the change in marital status, and it does not consider the duration in widowhood due to data limitation which may have a possible impact on the utilisation of inpatient health care services. Thirdly, the family history, kinship, and other aspects become essential to infer the health outcomes, which is missing in the study because this study uses cross-sectional data. A longitudinal survey can explore the history of kinship and the elderly's health care access. Fourthly, due to the nature of the cross-sectional dataset, the study is not able to adjust the utilisation of pre-widowhood healthcare services, which they used to access earlier. More sudies are needed to examine the association between marital status on health care utilisation for widowed individuals focusing on the role of household members on health care.