System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana

Abstract

Background In sub-Saharan African context, effect of system, institutional and client-level factors on formal healthcare utilisation among older adults with low income, especially those under a social protection scheme (called Livelihood Empowerment against Poverty [LEAP] programme) is least explored in the literature. However, an adequate understanding of how these factors contribute to formal healthcare utilisation among older adults who are classified as poor (in terms of low income) is important to inform health policy decisions. The aim of this study, therefore, was to examine the contributions of system, institutional and client-level factors in formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. Methods Data associated with this study were obtained from an Ageing, Health, Lifestyle and Health Services survey conducted between 1 and 20 June 2018 (N = 200) in the Atwima Nwabiagya Municipal and Atwima Nwabiagya North District of Ghana. Multivariable logistic regressions were used to determine system, institutional and client-level factors associated with formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. The significance of the test was set at a probability value of 0.05 or below. Results The study revealed that participants who relied on the LEAP programme and/or health insurance subscription to cater for their healthcare expenses (AOR: 11.934, CI: 1.151-123.777), those whose family/caregivers decided on when and where to use formal healthcare (AOR:12.409; CI: 2.198–70.076) and those who did not encounter communication problem with healthcare providers (AOR: 1.358; CI: 1.074–3.737) were significantly more likely to utilise formal healthcare services compared with their counterparts. The study further found that participants who perceived the attitude of healthcare providers as poor (AOR: 0.889; CI: 0.24–0.931) and those who spent 20–40 minutes at the healthcare facility were significantly less likely to utilise formal healthcare services compared with their counterparts (AOR: 0.070; CI: 0.006–0.195). Conclusion Our findings suggest that reducing waiting time at healthcare facilities, improving social protection and/or health insurance schemes, improving patient-doctor communication and promoting attitudinal change programmes (such as orientations and supportive supervision) for healthcare providers may help to facilitate the use of needed formal healthcare services by older adults with low income in Ghana.

Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method

“…Some studies have cited the creation of more awareness of the scheme’s benefits to improve its enrolments [ 19 , 25 ]. On the reduction of cost of care, earlier studies have supported such observations of enhancing access to health services at a reduced or no cost [ 23 , 59 ], and the removal or diminished cost burden in service utilisation [ 23 , 60 , 61 ]. It is extensively recognized that Ghana’s National Health Insurance Scheme has improved access to healthcare for many people including older persons despite issues of equity and sustainability [ 19 , 25 ].…”

“…Other researchers have reported otherwise. For instance, in older adults in Ghana 88.8% perceived treatment received as good, and 90.6% ranked the quality of healthcare as good [ 59 ].…”