Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa

Abstract

Background and objectiveThe achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries.DesignSecondary analysis of data from the World Health Organization’s Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use.ResultsIn the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions.ConclusionsThis study provides a basis for further investigation of country-specific responses to UHC.

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

“…Among need factors, chronic multimorbidity was positively associated with public and private healthcare utilization. This is in line with previous studies, which reported that having multiple chronic conditions was a strong predictor of healthcare utilization [6,11–13]. Results from a study in India indicated that the prevalence of chronic multimorbidity was high among older adults and utilization of outpatient care increased with an increasing number of chronic diseases [33].…”

“…Older adults who have multiple chronic conditions are known to have higher healthcare use [6,7]. Prior studies have reported the factors associated with healthcare utilization by older adults [8–10], including having multiple chronic conditions [11–13], high level of education [13], living alone, poor self-perceived health [14], older age, higher income, access to health insurance [12,15] and urban residence [16]. …”

Utilisation of outpatient healthcare services among elderly people with Hypertension in Ghana

“…As people cross this age group, their healthcare utilization is then determined by caregivers, who make most of the decisions regarding healthcare services. It has been argued that healthcare use tends to peak at 70-79 and thereafter declines in most developing countries [26]. Our findings are consistent with this line of argument.…”

“…That is issues relating to inequities were not prevalent since the effect of gender was statistically insignificant. The finding, in this regard, contradicts previous studies [3,24,26]. They found that elderly women used more outpatient healthcare services than men.…”

“…Using Global Aging and Adult Health (SAGE) China Wave 1 data, Dou et al [3] found that outpatient healthcare utilization among older people in China was influenced by age, sex, health insurance membership, and household wealth. Several other studies have investigated the factors affecting healthcare use among the elderly population [24][25][26], and they found that socio-economic factors play an important role in healthcare use. While several studies have examined healthcare utilization among the elderly in Ghana, studies focusing on elderly hypertensive patients remain scanty.…”