Study: How Distance Blocks Healthcare for India’s Elderly

They Travel 14 KM for Check-Ups, Over 40 KM for Hospital Care

April 26, 2025

Imagine being over 60 and having to travel 14 kilometres for a routine check-up and more than 40 kilometres for a hospital bed; a new study in a journal, The Lancet Regional Health – Southeast Asia, shows this is normal for India’s 138 million older adults, exposing how sheer distance—more than cost or doctors—now dictates whether they receive care at all.

People aged 60 and above made up 7.4 percent of the country in 2001; by 2031 they are expected to account for 13.2 percent, or roughly 138 million people, notes the study, titled “Miles to go before I seek.” Nearly half already live with two or more long-term illnesses that need regular monitoring and treatment, so their day-to-day survival depends on timely medical contact, it notes.

Reaching that contact is harder than the headline numbers on insurance cover or health-centre density suggest. Distance itself shapes decisions about when—or whether—to see a doctor, yet earlier Indian research concentrated mainly on financial barriers or health literacy.

The new study drew on 31,902 interviews from the first wave (2017-18) of the nationally representative Longitudinal Ageing Study of India, making it the largest data set so far that links kilometres travelled with real patterns of health-care use.

The researchers found that the average outpatient trip covered 14.5 km, while admission to hospital involved a journey three times as long at 43.6 km. Urban and rural experiences were worlds apart: two-thirds of city dwellers managed to see a doctor within 10 kilometres, but the median rural patient had to travel almost 28 km for the same service. When hospitalisation was needed, rural journeys were twice as long as urban ones. Almost every older person—95 percent—arranged private transport for inpatient admission; only five percent arrived by ambulance, a pattern that did not vary by residence.

Distance mattered not just in miles but in behaviour.

Where a clinic lay within 10 kilometres, 73 percent of older adults kept their outpatient appointments and 40 percent followed through with hospital admission when required. Move that facility past the 10-kilometre line and attendance plummeted: only 17 percent attended when the round trip was between 11 and 30 kilometres, dropping to 10 percent when the journey exceeded 30. Women, people living alone and those with little schooling or low income showed the sharpest fall-off, a sign that mobility limits and social isolation magnify the barrier created by geography.

Geography within India produced striking variations.

Kerala, Tripura and Manipur recorded the largest share of inpatient visits within 10 kilometres—59 percent, 80.4 percent and 74.7 percent respectively—reflecting either stronger local infrastructure or a habit of using the nearest facility in an emergency.

In contrast, hilly states such as Nagaland, Sikkim and Himachal Pradesh saw almost no admissions within that radius, and Mizoram, Nagaland and Himachal each sent more than a fifth of their older residents on journeys of at least 60 kilometres for hospital care. The pattern for outpatient visits ran in parallel: again the North-eastern and mountain states forced longer travel, whereas distances in the South were more even, implying a denser network of primary clinics.

A wait of hours in a bus or car before treatment has several consequences. First, it delays intervention, raising the risk of complications for chronic conditions such as heart disease or diabetes. Second, the prospect of that journey deters preventive visits, which is why the steepest drop in attendance shows up in routine outpatient care. Third, it pushes families with limited cash toward selling assets or taking informal loans to pay for transport.

The authors propose practical remedies that match the different layers of the health system.

At the community level, mobile medical vans, doorstep consultations via telemedicine and subsidised local transport schemes could bring basic care to patients rather than the reverse.

Strengthening Ayushman Arogya Mandir centres – government-run health centres that provide free, comprehensive primary care – would give rural districts a stable point for diagnosis and drug dispensing, while better-equipped district hospitals could cut unwanted referrals to distant tertiary centres. Their analysis notes that similar transport-support programmes in other countries have raised attendance and improved outcomes without excessive cost.

The chief lesson from the study is clear. Even when consultations are nominally free and insurance schemes promise cashless admission, a 10-kilometre stretch of bad road can still keep an older person from care. Closing that distance—physically and in service design—will decide whether India’s universal health-care ambitions reach the people who now need them most. 

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