The role of transportation in older adults' use of and satisfaction with primary care in China

Introduction: Access to transportation is a major but oft-overlooked factor in the use of primary care and in the level of satisfaction with these services. This study uses an extended version of the Andersen Behavioral Model of Health Services Use to examine these two features of primary care in a nationally representative sample of older adults in China. Methods: Data are from 1859 adults aged 65 years and older in Wave 1 of the WHO Study on Global AGEing and Adult Health (SAGE). We used a negative binominal regression to assess the association of mode, time and costs of transportation with frequency of primary care visits and an ordered logit regression to determine the level of satisfaction with those visits. Findings: For persons who drive, taxi, or otherwise pay for transit, travel time is related to frequency of primary care visits. Transportation costs are also related to satisfaction, but $1 spent on transportation does not differ from $1 spent on other items related to a primary care visit. Individuals who walk have higher levels of satisfaction than those who drive. Other predisposing, enabling and need factors, including geography, socio-economic status, chronic health conditions and social supports are also associated with primary care visit frequency and satisfaction. Conclusions: Promoting active travel modes among the older population and community-level health facility planning enhances older adults' use of and satisfaction with primary care visits. Transportation strategies should be an integral part of health interventions with this population.