Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians

Abstract

BackgroundThere is a lack of focused research on the older population in Ghana and about issues pertaining to their access to healthcare services. Furthermore, information is lacking regarding the fairness in the access to these services. This study aimed to ascertain whether horizontal and vertical equity requirements were being met in the healthcare utilisation among older adults aged 50 years and above.MethodsThis study was based on a secondary cross-sectional data from the World Health Organization’s Study on global AGEing (SAGE) and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Bivariate and multivariable analyses were carried out to analyse the association between outpatient/inpatient utilisation and (1) socioeconomic status (SES), controlling for need variables (horizontal equity) and (2) need variables, controlling for SES (vertical equity). Odds ratios with 95% confidence intervals were calculated to analyse the association between relevant variables.ResultsHorizontal and vertical inequities were found in the utilisation of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services.ConclusionWhilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The study reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access. It provides the basis for further research in bridging the healthcare access inequity gap among older adults in Ghana.

Difficulties in accessing health services among the elderly in the city of São Paulo-Brazil

“…The analyses on predisposing characteristics also showed that aspects related to age group and schooling acted as factors for the difficulty of access to health services among the elderly. It was observed that younger elderly people presented increased chances of difficulty in accessing health services when compared to younger ones, a result similar to that found by other studies [ 23 , 44 , 50 ]. A study conducted in Ghana, Africa, on equity in the use of health services by individuals aged 50 years and more identified an increasing association between the use of services and the increase in age, to the point that elderly people aged 80 years and older presented an increased chances of 1.69 [1.20, 2.37] of use of outpatient services when compared to those aged 50 to 59 years [ 44 ].…”

“…Another aspect that was configured as a protective factor for access to health services in the elderly studied was the fact that individuals with higher schooling had a lower chances of reporting access difficulties when compared to those without schooling, a result that corroborated other studies [ 14 , 21 , 23 , 44 , 51 ]. A study conducted with a stratified and representative sample of the Ghanaian population identified a positive and statistically significant association between access to outpatient services and schooling, so that elderly with higher education and high school had 1.60 [1.00,2.55] and 1.68 [1.27,2.23] respectively, higher probability of accessing outpatient care when compared to illiterate patients [ 44 ].…”

“…It was observed that elderly females had greater difficulty accessing health services when compared to males, a result that does not corroborate the findings of other studies that sought to perform a gender analysis [ 23 , 43 , 44 ]. A population survey in Zhejiang Province, China, which sought to examine access to health services among the elderly, identified that women living in urban areas had lower chances of difficulty in hospitalization due to need when compared to men [ 43 ].…”

Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana

“…In most cases, the utilisation of formal healthcare is viewed as receiving medical treatment from a health provider at a facility including hospitals, health centres and clinics [15]. In Ghana, whereas 51.7% of the general population utilise healthcare facilities [16], between 17.8 and 52.41% of older people respectively utilise private and public healthcare facilities [17,18]. Factors that predict such healthcare utilisation include health insurance status [19], education, gender [16,19], age, social status, marital status, ethnicity, religion, family size, employment and type of occupation [16].…”

Redistribution and the health financing transition

“…The concepts of ‘horizontal equity’ and ‘vertical equity’ become relevant while addressing this dilemma. Horizontal equity would enjoin us to treat all members of the population equally in terms of their entitlements, while vertical equity would aim to reduce the gaps in health status between population groups by giving greater attention to the groups that presently have a worse health profile and are economically disadvantaged [ 3 , 4 ].…”