Disability-based disparity in outpatient health system responsiveness among the older adults in low- to upper-middle-income countries.

Health system responsiveness (HSR) has been identified as one of the intrinsic goals of health systems for improvement in health and well-being of population. The HSR deals with the non-medical, legitimate expectations of a population in its interaction with the health system. It becomes essential in case of vulnerable groups like older adults with disability, who are more sensitive and risk-prone to the adversities of healthcare challenges. This paper uses data from the Study on Global Ageing and Adult Health conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007-10 and examines the disability-based disparity in outpatient HSR among the older adults in the above-mentioned countries. Disability and HSR scores have been constructed using Item Response Theory Partial Credit Model. Also, the paper uses bivariate and multivariate analysis and finds that the HSR is significantly and substantially lower among the disabled and severely disabled older adults in all the study countries (except Ghana) as compared with those older adults who are not (or mildly) suffering from any form of disability. The policy efforts in the studied countries should focus on monitoring and reducing these disparities for improving HSR in order to make it inclusive.