Determinants of Healthcare Service Utilization by the Elderly: An Integrative Literature Review of Physical Accessibility, Information Technology Access, Healthcare Costs, and Family Social Support
Keywords:
Older adults, Health Service Utilization, Accessibility, Digital Divide, Family Social Support
Abstract
Population ageing makes health service utilization among older adults a strategic public service issue. The 2025 Intercensal Population Survey (SUPAS) recorded that older persons account for 11.97% of Indonesia's population, yet nearly half of older adults reporting health complaints do not use formal health services. This study analyzes the determinants of health service utilization among older adults in terms of physical accessibility, access to information technology, and health costs, and examines the role of family social support as a moderating variable. An integrative literature review was combined with a descriptive analysis of secondary data from Statistics Indonesia, the Ministry of Health, and official reports. Articles published in 2016–2026 were retrieved from Google Scholar, Garuda, PubMed Central, and DOAJ, purposively selected, and synthesized thematically. The findings show that (1) shorter travel time and lower transport costs increase the likelihood of facility use; (2) internet use is positively associated with outpatient care, while the digital divide among older adults remains wide; (3) health insurance ownership is the most consistent enabling factor, although indirect costs remain a barrier; and (4) family social support may buffer the negative effects of access barriers, but the evidence is inconsistent due to differing measurements. This review proposes a conceptual model with four testable propositions and recommends integrated elderly health service policies that combine outreach services, digital assistance, financial protection, and stronger family involvement.
References
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Heart, T., & Kalderon, E. (2013). Older adults: Are they ready to adopt health-related ICT? International Journal of Medical Informatics, 82(11), e209–e231. https://doi.org/10.1016/j.ijmedinf.2011.03.002
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Ipa, M., Laksono, A. D., & Wulandari, R. D. (2023). The role of travel time on hospital utilization in the islands area: A cross-sectional study in the Maluku Region, Indonesia, in 2018. Indian Journal of Community Medicine, 48(2), 269–273. https://doi.org/10.4103/ijcm.ijcm_229_22
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Laksono, A. D., Wulandari, R. D., Rohmah, N., Rukmini, R., & Tumaji, T. (2023). Regional disparities in hospital utilisation in Indonesia: A cross-sectional analysis data from the 2018 Indonesian Basic Health Survey. BMJ Open, 13(1), e064532. https://doi.org/10.1136/bmjopen-2022-064532
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Megatsari, H., Nandini, N., & Laksono, A. D. (2023). Health center utilization among the elderly in the East Java Province. Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Education, 11(1).
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Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 12–40.
Park, J. M. (2014). Health status and health services utilization in elderly Koreans. International Journal for Equity in Health, 13, 73. https://doi.org/10.1186/s12939-014-0073-7
Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127–140. https://doi.org/10.1097/00005650-198102000-00001
Peraturan Menteri Kesehatan Republik Indonesia Nomor 67 Tahun 2015 tentang Penyelenggaraan Pelayanan Kesehatan Lanjut Usia di Pusat Kesehatan Masyarakat. (2015).
Peraturan Presiden Republik Indonesia Nomor 88 Tahun 2021 tentang Strategi Nasional Kelanjutusiaan. (2021).
Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Rahman, M. H. (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences, 1136, 161–171. https://doi.org/10.1196/annals.1425.011
Putri, N. K., Laksono, A. D., & Rohmah, N. (2023). Predictors of national health insurance membership among the poor with different education levels in Indonesia. BMC Public Health, 23(1), 373.
Rahardja, M. B., Puspitasari, M. D., & Surbakti, I. M. (2024). Internet usage and its utilization for outpatient treatment among older adults in Indonesia: Evidence from the 2020 National Socioeconomic Survey. Althea Medical Journal, 11(3), 137–143. https://doi.org/10.15850/amj.v11n3.3404
Shrestha, R. (2021). Health insurance for the poor, healthcare use and health outcomes in Indonesia. Bulletin of Indonesian Economic Studies, 57(1), 85–110.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339. https://doi.org/10.1016/j.jbusres.2019.07.039
Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: Transportation barriers to health care access. Journal of Community Health, 38(5), 976–993. https://doi.org/10.1007/s10900-013-9681-1
Terfa, Y. B., Germossa, G. N., Hailu, F. B., Feyissa, G. T., Jaleta, F. T., & Shinkie, S. O. (2019). Determinants of health care utilization among the elderly population in Jimma Town, Oromia Region, Southwest Ethiopia. International Archives of Nursing and Health Care, 5(3). https://doi.org/10.23937/2469-5823/1510131
Torraco, R. J. (2005). Writing integrative literature reviews: Guidelines and examples. Human Resource Development Review, 4(3), 356–367. https://doi.org/10.1177/1534484305278283
Undang-Undang Republik Indonesia Nomor 17 Tahun 2023 tentang Kesehatan. (2023).
Valtorta, N. K., Moore, D. C., Barron, L., Stow, D., & Hanratty, B. (2018). Older adults' social relationships and health care utilization: A systematic review. American Journal of Public Health, 108(4), e1–e10. https://doi.org/10.2105/AJPH.2017.304256
van Dijk, J. (2020). The digital divide. Polity Press.
Vroman, K. G., Arthanat, S., & Lysack, C. (2015). "Who over 65 is online?" Older adults' dispositions toward information communication technology. Computers in Human Behavior, 43, 156–166. https://doi.org/10.1016/j.chb.2014.10.018
Wang, X., & Luan, W. (2022). Research progress on digital health literacy of older adults: A scoping review. Frontiers in Public Health, 10, 906089. https://doi.org/10.3389/fpubh.2022.906089
Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
World Health Organization. (2015). World report on ageing and health. World Health Organization.
World Health Organization. (2021). Decade of healthy ageing: Baseline report. World Health Organization.
Wulandari, R. D., & Laksono, A. D. (2019). Urban-rural disparity: The utilization of primary healthcare centers among elderly in East Java, Indonesia. Jurnal Administrasi Kesehatan Indonesia, 7(2).
Wulandari, R. D., Laksono, A. D., Mubasyiroh, R., Rachmalina, R., Ipa, M., & Rohmah, N. (2023). Hospital utilization among urban poor in Indonesia in 2018: Is government-run insurance effective? BMC Public Health, 23(1), 92.
Wulandari, R. D., Supriyanto, S., Qomaruddin, M. B., & Laksono, A. D. (2019). Socioeconomic disparities in hospital utilization among elderly people in Indonesia. Indian Journal of Public Health Research & Development, 10(11), 2192–2196.
Xie, X., Lyu, Y., Li, X., Zhuang, Z., & Xu, A. (2024). Exploring the association between social isolation and utilization of primary health services by older adults: Evidence from China. Frontiers in Public Health, 12, 1341304. https://doi.org/10.3389/fpubh.2024.1341304
Published
2026-10-18
How to Cite
Romi Oktarian Novasari, Andries Lionardo, & Alamsyah, A. (2026). Determinants of Healthcare Service Utilization by the Elderly: An Integrative Literature Review of Physical Accessibility, Information Technology Access, Healthcare Costs, and Family Social Support. International Journal of Education, Vocational and Social Science , 5(04), 3225-3245. https://doi.org/10.63922/ijevss.v5i04.6913
Contact Person +6282139474255
Email : ijevss@citakonsultindo.or.id / editor.ijevss@gmail.com
