Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana

Abstract

Background: Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services. The present study examined factors associated with public and private healthcare service use, and the resulting perceived health system responsiveness. Objectives: To identify factors associated with public and private healthcare utilization among older adults aged 50 and older in Ghana; and to compare perceived differences in health system responsiveness between the private and public sectors. Methods: Cross-sectional data was analyzed from the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 in Ghana. Using Andersen’s conceptual framework, public and private outpatient care utilization was examined using multinomial logistic regression to estimate and identify predictor variables associated with the type of outpatient healthcare facility accessed. Health system responsiveness was compared using chi-square tests. Results: Of 2517 respondents who used outpatient care in the 12 months preceding interview, 51.7% of respondents used a public facility, 17.8% a private facility, and 30.5% used other facilities. Older age group, higher education and higher wealth were associated with the use of private outpatient healthcare services. Using public outpatient care facilities was associated with having health insurance. Respondents with two or more chronic conditions were more likely to use public and private outpatient care than other facilities. Perceived health system responsiveness was better in private for-profit than in public and private not-for-profit healthcare facilities. Conclusions: This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; however, health insurance was a predictor only for the use of public facilities. Future mixed-method studies could further elucidate factors influencing the choice of public and private outpatient healthcare use.

Factors influencing healthcare use among poor older females under the Livelihood Empowerment Against Poverty programme in Atwima Nwabiagya District, Ghana

“…Despite an association between age and healthcare use in this study which is consistent with previous studies [30][31][32][33], the finding that respondents aged between 85 and 89 years were significantly less likely to use healthcare was counter-intuitive and appeared inconsistent with our expectation and earlier studies in LMICs. This is because, a study in 16 European countries revealed that the propensity of having multimorbidities increased considerably with advancing age [34].…”

Responsiveness of The Health Care System Towards The Elderly In Tanzania: Does Health Insurance Make a Difference? A cross Sectional Study

“…Among the independent variables, older age, women and married people showed a negative statistically significant association to responsiveness in outpatient care. The result regarding age is, however, opposite to other studies 6,26 that have reported more responsiveness by older people. One possible explanation might be that health care services are used more often with age making elderly more negative towards them.…”

“…3,4 Compounding this situation is the increasing need for health care services adapted to noncommunicable diseases like diabetes, hypertension, a variety of cancers and deteriorating physical mobility, which predominantly affect the elderly. 5,6 Many LMICs have initiated reforms to their health care systems with a focus on improving the availability and accessibility of health care services for this vulnerable population group. These reforms are in line with the World Health Organization's (WHO) proclamation for universal health coverage (UHC), which focuses at building an enabling health system that is able to provide equitable health care access and financial protection to the people, regardless of their capacity to pay.…”

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].…”