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Liang Y, Lin Y, Jiao B. Health Interventions May Have Divergent Impacts on Health and Economic Equity: A Case Study of the Community-Based Hypertension Improvement Project in Ghana. Appl Health Econ Health Policy 2024; 22:353-362. [PMID: 38267804 DOI: 10.1007/s40258-024-00871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Improving health and economic equity are key objectives in priority setting, particularly in low-income and middle-income countries. This study aims to assess the distributional impacts of the Community-based Hypertension Improvement Project (ComHIP) on health and economic outcomes across wealth quintiles in Ghana. METHODS We developed a decision analytical model to simulate a 30 million cohort of Ghanaians aged 15-49 years. The study specified health outcomes as the prevention of stroke cases and averting deaths among those with hypertension. Furthermore, we explored economic impacts, including savings in out-of-pocket costs for stroke patients and government spending. Financial risk protection against catastrophic and impoverishing health expenditures was also examined. We assessed these outcomes across wealth quintiles, and the corresponding concentration indexes (CIXs) were determined. RESULTS It was estimated that ComHIP could prevent 1450 stroke cases and 564 related deaths annually. Health benefits were observed to be more significant among the wealthier quintiles (CIX 0.217), mainly attributed to a higher occurrence of hypertension within these groups. ComHIP was also projected to result in an annual saving of USD 49,885 in individuals' out-of-pocket costs (CIX 0.262) and USD 37,578 in government spending (CIX 0.146). These savings correspond to the prevention of 335 catastrophic health expenditure cases (CIX - 0.239) and 11 impoverishing health expenditure cases (CIX - 0.600). CONCLUSIONS While ComHIP provides greater health benefits to wealthier groups, it offers substantial financial risk protection for the less wealthy. This study highlights the importance of considering equity in both health and financial risk when making priority-setting decisions.
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Affiliation(s)
- Yizhi Liang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA
| | - Yuqian Lin
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA
| | - Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA.
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Zigah EY, Abu-Ba'are GR, Shamrock OW, Dakpui HD, Apreku A, Boyd DT, Nelson LE, Torpey K. "For my safety and wellbeing, I always travel to seek health care in a distant facility"-the role of place and stigma in HIV testing decisions among GBMSM - BSGH 002. Health Place 2023; 83:103076. [PMID: 37423093 DOI: 10.1016/j.healthplace.2023.103076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
Gays, bisexuals, and all other men who have sex with men (GBMSM) are heavily impacted by HIV in Ghana compared to the general population. In addition to HIV and same-sex intercourse stigma, barriers such as reduced privacy, lower-income status and limited health care facilities (HCF) affect HIV testing decisions among GBMSM. We employed a phenomenological research design to understand the role of place and stigma in HIV testing among GBMSM in slums. GBMSM (n = 12) from slums in Accra and Kumasi, Ghana, were recruited and engaged in face-to-face interviews. We used a multiple reviewer summative content analysis to analyze and organize our key findings. The HIV testing options we identified include 1. Government HCF, 2. NGO and community outreach 3. Peer-educated services. Factors influencing GBMSM to test for HIV at HCF outside their areas included 1. The location of HCF 2. HIV and sexual stigma from slum areas 3. Positive HCW attitudes at distant HCF. 4. Negative Healthcare worker (HCW) attitudes towards GBMSM. These findings highlighted how stigma from slums and HCW influence HIV testing decisions and the need for place-based interventions to address stigma among HCW in slums to improve testing among GBMSM.
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Affiliation(s)
- Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana.
| | - Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana; Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA
| | - Osman Wumpini Shamrock
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA
| | - Henry Delali Dakpui
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- School of Public Health, University of Ghana, Accra, Ghana
| | - Donte T Boyd
- College of Social Work, Ohio State University, Columbus, OH, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA
| | - Kwasi Torpey
- School of Public Health, University of Ghana, Accra, Ghana
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Braimah JA, Agyemang-Duah W, Amoak D, Sano Y, Antabe R, Dassah E. Healthcare seeking behaviour during illness among older adults in Ghana: does food security status matter? BMC Geriatr 2023; 23:327. [PMID: 37231374 DOI: 10.1186/s12877-023-04023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ghana's growing older adult population raises critical questions regarding healthcare for these older adults. At the same time, food insecurity is high among older adults in Ghana. This underscores the need to investigate the issues of food security and healthcare seeking behaviour among older adults. However, research on the association between food security status and healthcare seeking behaviour among older adults is scant in the Ghanaian context. In this study, we advance the social gerontology literature by examining the association between food security status and healthcare seeking behaviors among older adults. METHODS Using a multi-stage sampling framework, we collected data from a representative sample of older adults across three regions in Ghana. Data were analyzed using logistic regression technique. We determined the significance of the test at a probability value of 0.05 or less. RESULTS Over two-thirds (69%) of respondents did not seek care during their last illness. Additionally, 36% of respondents were severely food insecure, 21% were moderately food insecure, 7% were mildly food insecure, and 36% were food secure. After controlling for theoretically relevant variables, our multivariable analysis revealed a statistically significant association between food security status and healthcare seeking behaviors with older people who are food secure (OR = 1.80, p < 0.01) and mildly food insecure (OR = 1.89, p < 0.05) being more likely to seek healthcare compared with their counterparts who are food insecure. CONCLUSION Our findings highlight the need for sustainable intervention programs to improve food access and health service use among older adults in Ghana and similar contexts.
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Affiliation(s)
- Joseph Asumah Braimah
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | | | - Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Kitole FA, Lihawa RM, Nsindagi TE, Tibamanya FY. Does health insurance solve health care utilization puzzle in Tanzania? Public Health 2023; 219:91-101. [PMID: 37146487 DOI: 10.1016/j.puhe.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/25/2023] [Accepted: 03/30/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES The global target of achieving universal health coverage by 2030 is a nightmare in most developing countries. To seek in-depth reasons, this study examines the effects of health insurance on healthcare utilization in Tanzania. STUDY DESIGN This study used a non-experimental research design. METHODS Probit model, negative binomial regression, and instrumental variable Poisson with generalized method of moments were used to solve the healthcare utilization puzzle by the use of Andersen Health Care Utilization Model by using the Tanzania Panel Survey data of 2020/21. RESULTS The findings showed that education level, income, age, residence, household size, insurance, and distance from homestead to health facilities are significant policy intervention factors for improving households' healthcare utilization behavior among households in Tanzania. CONCLUSION Prioritize should be made on interventions that ensure the affordability of health services without compromising the quality of services offered and expanding the share of the government budget on health sector.
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Hossain B, James KS, Nagargoje VP, Barman P. Differentials in private and public healthcare service utilization in later life: do gender and marital status have any association? J Women Aging 2023; 35:183-193. [PMID: 34851802 DOI: 10.1080/08952841.2021.2011562] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied to examine the association of private and public inpatient healthcare utilization with the marital status of the elderly. The study found that widowed men and women generally used public healthcare for hospitalization, while married men and women preferred private healthcare. Our findings also indicated that private inpatient health services expenditure was higher for married elderly than widowed elderly. After controlling all covariates, widowhood was significantly associated with higher use of public healthcare services for women but not for men. India's current health care policy and program may be required to focus on improving the infrastructure quality of current public healthcare systems. It also needs to be favorable for vulnerable sections of society, especially widowed women, to avail better treatment at an affordable cost.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - K S James
- International Institute for Population Sciences (IIPS), Mumbai, India
| | | | - Papai Barman
- International Institute for Population Sciences (IIPS), Mumbai, India
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Moeti T, Mokhele T, Weir-Smith G, Dlamini S, Tesfamicheal S. Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa. Int J Environ Res Public Health 2023; 20:3651. [PMID: 36834345 PMCID: PMC9958907 DOI: 10.3390/ijerph20043651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Access to healthcare services is largely determined by socioeconomic factors, with economically well-off individuals obtaining healthcare services more efficiently than those who are disadvantaged. This paper aims to assess the effects of socioeconomic and other related factors on access to healthcare facilities in the City of Tshwane, South Africa, during the COVID-19 pandemic. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Multivariate logistic regression was applied. Results showed that 66.3% of the respondents reported that they had access to public healthcare facilities within their area. Furthermore, results showed that those who lived in informal houses were significantly (OR = 0.55, 95% CI [0.37-0.80], p < 0.01) less likely to report that they had access to public healthcare facilities in their area compared to those who lived in formal houses. More efforts need to be undertaken to ensure that all citizens have access to public healthcare facilities, especially among those who are disadvantaged, such as informal dwellers. In addition, future research should encompass locality in relation to the factors that affect access to public healthcare facilities, especially during pandemics such as the COVID-19 pandemic, in order to have geographically targeted interventions.
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Affiliation(s)
- Thabiso Moeti
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
- Geography, Environmental Management and Energy Studies, University of Johannesburg, Johannesburg 2006, South Africa
| | - Tholang Mokhele
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
| | - Gina Weir-Smith
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
- Geography, Archaeology and Environmental Studies, Wits University, Johannesburg 2000, South Africa
| | - Simangele Dlamini
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
| | - Solomon Tesfamicheal
- Geography, Environmental Management and Energy Studies, University of Johannesburg, Johannesburg 2006, South Africa
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Askari MH, Gupta K. Understanding the health care utilization behavior to achieve the sustainable development goals—a comparative study of Malda District, India. SN Soc Sci 2022; 2:166. [PMID: 35996415 PMCID: PMC9387417 DOI: 10.1007/s43545-022-00474-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
The Sustainable Development Goals were finalized in September 2015 by following and expanding Millennium Development Goals with newer targets under the principle of ‘leaving no one behind’. One of the 17 goals is devoted to health (Goal number 3). Understanding the health care utilization behavior is essential to attain the health goal by providing adequate and quality health services. The study seeks to understand the health care utilization behavior and its determinants in Malda district, India. For this study, the primary data are collected through a household survey with a pre-designed schedule. For that, for a comparative discussion, Englishbazar and Chanchal- II blocks have been chosen by purposive sampling considering the best and worst health conditions, respectively. The sample size was 100 families for each block. Analytical methods like chi-square, correlation, and regression analysis are used for the study. The four categories of treatment patterns that have been recognized in the study area; are self-treatment, government institution, qualified doctors and private institution, and the presence of quack doctors. People’s education and income were the confounding factors of such treatment patterns. Many of the respondents are getting treatment from quack doctors or rely on self-treatment based on their very little knowledge of medicine, resulting from a lack of awareness among local communities. It may be concluded that besides socio-economic factors, the availability of insufficient health care facilities influences the health care utilization behavior in the study area.
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Affiliation(s)
- Md. Hasan Askari
- Department of Geography, Turku Hansda Lapsa Hemram Mahavidyalay, Mallarpur, Birbhum, West Bengal 731216 India
| | - Krishnendu Gupta
- Department of Geography, Visva Bharati, Birbhum, West Bengal India
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Ramos NNV, Fronteira I, Martins MRO. Building a Health Literacy Indicator from Angola Demographic and Health Survey in 2015/2016. Int J Environ Res Public Health 2022; 19:ijerph19052882. [PMID: 35270574 PMCID: PMC8910521 DOI: 10.3390/ijerph19052882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023]
Abstract
Health literacy is a determinant factor for population health. It is important both for the prevention of health problems and the better management of those problems and unexpected situations that happen. Low health literacy has been consistently associated with poor health outcomes. This study aimed to develop a health literacy indicator for Angola and to analyze pertinent demographic characteristics related to it. Data were obtained from the first Angola Demographic and Health Survey conducted in 2015/16; we included 10 questions related to the American National Academy of Medicine definition of health literacy. Using factor analysis, we extracted one i indicator corresponding to four dimensions of health literacy. The indicator was dichotomized, and we used Logistic Regression to estimate factors associated with health literacy level: we obtained data from 19,785 adolescents and adults, aged 15–49 years. The internal consistency of the i indicator was reliable (Cronbach’s α = 0.83). Adjusting for other variables, males with complete secondary education or above and living in urban areas were more likely to have a high level of health literacy. There were substantial differences between the 18 regions. This is the first study evaluating health literacy in Angola using the American National Academy of Medicine definition and a Demographic and Health survey. Our study shows unfavorable results for women, individuals living in rural areas and those less educated.
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Rizwan L, Malagón M, Richter S. Understanding the Influence of Ghanaian Women’s Migration Patterns on Access to Health Care. Women 2022; 2:30-43. [DOI: 10.3390/women2010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Increased migration rates demonstrate a rise in women seeking relocation as a means to access employment or academic opportunities; this is referred to as the feminization of migration. Migration stimulates female empowerment, increases access to financial opportunities, and promotes cultural diversity, all while simultaneously exposing women to detrimental conditions that impose risks to their physical and psychological well-being. Health is a fundamental human right that female migrants often are deprived of due to various social, cultural, political, and economic factors. A secondary analysis design was implemented to explore the impact of social determinants of health, specifically socioeconomic status, culture, and education, on health outcomes and health care access of Ghanaian internal and external female migrants. Interviews collected from two primary studies were analyzed using thematic analysis and an intersectionality approach. Ghanaian female migrants experienced cultural, financial, social, and health accessibility related barriers in accessing health care services. Our findings will serve as a foundation for improving health outcomes for female migrant populations and support health care professionals’ practice of cultural competence.
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Bastani P, Mohammadpour M, Samadbeik M, Bastani M, Rossi-Fedele G, Balasubramanian M. Factors influencing access and utilization of health services among older people during the COVID - 19 pandemic: a scoping review. Arch Public Health 2021; 79:190. [PMID: 34743747 PMCID: PMC8572573 DOI: 10.1186/s13690-021-00719-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022] Open
Abstract
Background Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. The aim of the study is to explore factors affecting healthcare access and health service utilization for older people during the pandemic. Methods PubMed, Web of Science, Scopus and Embase were systematically searched for relevant articles. Access, utilization, health, elderly and COVID-19 were used as keywords in the search strategy. A total of 4308 articles were identified through the initial database search; 50 articles were included in the review as passing the eligibility criteria. The searches were conducted up to August 2021. Data extraction was performed, and evidence was descriptively illustrated. Thematic analysis was used to explore factors influencing the elderly’s access and utilization of healthcare services, using Max QDA10, a qualitative analysis software. Results Among articles included in the review (n = 50), a majority of the studies were from the United States (36%), followed by India (8%). According to the main healthcare services, a large number of articles (18%) were related to mental health services, followed by digital health services (16%). Factors were identified at an individual, provider and systems level. Seven main themes emerged from the thematic analysis, as determinants of elderly’s access and utilization of healthcare services during COVID-19 pandemic. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants. Conclusion Mental health and digital health services were identified as major issues influencing or contributing to or influencing older people’s health during the COVID-19 pandemic. We also argue on the importance of a rounded view, as attention to a range of factors is vital for policy decisions towards sustainable care and equitable interventions for improving the health of older people. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00719-9.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahnaz Samadbeik
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Misagh Bastani
- Anesthesiologist, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Madhan Balasubramanian
- Research Fellow and Lecturer, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Mangipudi S, Cosco T, Harper S. A systematic review of physical and psychological health and wellbeing of older women in Sub-Saharan Africa. J Public Health (Oxf) 2021; 42:294-303. [PMID: 30844047 DOI: 10.1093/pubmed/fdz013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the fastest growing proportion of older adults in the world, the majority of whom are women. Global health agendas, however, continue to deprioritise older women's health issues, including the incidence of and mortality from non-communicable disease (NCDs). This is the first systematic review to address the health, wellbeing and healthcare utilization of older SSA women. METHODS Studies with primary analysis of health, wellbeing and/or healthcare utilization outcomes for women over the age of 50 from SSA countries were included. Databases searched include EMBASE, Scopus and Psycinfo. FINDINGS About 26 studies from six SSA countries met inclusion criteria. Studies regarding NCDs predominated (n = 12), followed by healthcare utilization (n = 4), disability (n = 4), wellbeing (n = 2), depression (n = 2) and HIV (n = 2). Every study indicated significantly lower self-rated health and wellbeing, higher rates of depression, hypertension, obesity, disability or weakness for women compared with men. The studies also indicated that older women use healthcare more often, and choose public over private facilities more often. INTERPRETATION The studies in the review had large, diverse samples. This review demonstrates the need for more gender-specific studies to better understand the unique challenges older women face in managing NCDs in particular.
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Affiliation(s)
| | - Theodore Cosco
- Gerontology Research Center, Simon Fraser University, Vancouver, Canada
| | - Sarah Harper
- Oxford Institute of Population Ageing, University of Oxford, 66 Banbury Rd. Oxford, UK
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Tungu M, Amani PJ, Hurtig AK, Dennis Kiwara A, Mwangu M, Lindholm L, San Sebastiån M. Does health insurance contribute to improved utilization of health care services for the elderly in rural Tanzania? A cross-sectional study. Glob Health Action 2021; 13:1841962. [PMID: 33236698 PMCID: PMC7717594 DOI: 10.1080/16549716.2020.1841962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Health care systems in developing countries such as Tanzania depend heavily on out-of-pocket payments. This mechanism contributes to inefficiency, inequity and cost, and is a barrier to patients seeking access to care. There are efforts to expand health insurance coverage to vulnerable groups, including older adults, in Sub-Saharan African countries. Objective: To analyse the association between health insurance and health service use in rural residents aged 60 and above in Tanzania. Methods: Data were obtained from a household survey conducted in the Nzega and Igunga districts. A standardised survey instrument from the World Health Organization Study on global AGEing and adult health was used. This comprised of questions regarding demographic and socio-economic characteristics, health and insurance status, health seeking behaviours, sickness history (three months and one year prior to the survey), and the receipt of health care. A multistage sampling method was used to select wards, villages and respondents in each district. Local ward and hamlet officers guided the researchers in identifying households with older people. Crude and adjusted logistic regression methods were used to explore associations between health insurance and outpatient and inpatient health care use. Results: The study sample comprised 1,899 people aged 60 and above of whom 44% reported having health insurance. A positive statistically significant association between health insurance and the utilisation of outpatient and inpatient care was observed in all models. The odds of using outpatient (adjusted OR = 2.20; 95% CI: 1.54, 3.14) and inpatient services (adjusted OR = 3.20; 95% CI: 2.46, 4.15) were higher among the insured. Conclusion: Health insurance is a predictor of outpatient and inpatient health services in people aged 60 and above in rural Tanzania. Further research is needed to understand the perceptions of both the insured and uninsured regarding the quality of care received.
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Affiliation(s)
- Malale Tungu
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania.,Epidemiology and Global Health, Umeå University , Umeå, Sweden
| | - Paul Joseph Amani
- Epidemiology and Global Health, Umeå University , Umeå, Sweden.,Department of Health Systems Management, School of Public Administration and Management, Mzumbe University , Morogoro, Tanzania
| | | | - Angwara Dennis Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
| | - Mughwira Mwangu
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
| | - Lars Lindholm
- Epidemiology and Global Health, Umeå University , Umeå, Sweden
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Huang FY, Ho CH, Liao JY, Hsiung CA, Yu SJ, Zhang KP, Chen PJ. Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter? PLoS One 2021; 16:e0247622. [PMID: 33630929 PMCID: PMC7906386 DOI: 10.1371/journal.pone.0247622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
Studies about medical care needs for home healthcare (HHC) previously focused on disease patterns but not gender and income differences. We used the Taiwan National Health Research Insurance Database from 1997 to 2013 to examine trends in medical care needs for patients who received HHC, and the gender and income gaps in medical care needs, which were represented by resource utilization groups (RUG). We aimed to clarify three questions: 1. Are women at a higher level of medical care needs for HHC than men, 2. Does income relate to medical care needs? 3. Is the interaction term (gender and income) related to the likelihood of medical care needs? Results showed that the highest level of medical care need in HHC was reducing whereas the basic levels of medical care need for HHC are climbing over time in Taiwan during 1998 and 2013. The percentages of women with income-dependent status in RUG1 to RUG4 are 26.43%, 26.24%, 30.68%, and 32.07%, respectively. Women were more likely to have higher medical care needs than men (RUG 3: odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25; RUG4: OR = 1.13, 95% CI = 1.06-1.22) in multivariates regression test. Compared to the patients with the high-income status, patients with the income-dependent status were more likely to receive RUG3 (OR = 2.34, 95% CI = 1.77-3.09) and RUG4 (OR = 1.98, 95% CI = 1.44-2.71). The results are consistent with the perspectives of fundamental causes of disease and feminization of poverty theory, implying gender and income inequalities in medical care needs. Policymakers should increase public spending for delivering home-based integrated care resources, especially for women with lower income, to reduce the double burden of female poverty at the higher levels of medical care needs for HHC.
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Affiliation(s)
- Fang-Yi Huang
- Department of Social and Policy Sciences, Yuan Ze University, Taoyuan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | | | | | - Ping-Jen Chen
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Zon H, Pavlova M, Groot W. Factors associated with access to healthcare in Burkina Faso: evidence from a national household survey. BMC Health Serv Res 2021; 21:148. [PMID: 33588836 PMCID: PMC7885251 DOI: 10.1186/s12913-021-06145-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/02/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Burkina Faso has undertaken major reforms, the cornerstone of which has been the decentralization of the health system to increase access to primary healthcare and to increase the effectiveness, efficiency, financial viability and equity of health services. This study aims to analyze the socio-demographic determinants of households' access to healthcare in Burkina Faso. METHODS We used data from a national household survey conducted in 2014 in Burkina Faso. We carried out binary logistic and linear regression analysis using data from a national household survey. The statistical analysis explored the associations between socio-demographic characteristics on the one side, and the use of health services, satisfaction with health services and expenditures on health services, on the other side. RESULTS The findings indicate an association between age, education, income and use of services (p < 0.0005). The results show that healthcare users' satisfaction is influenced by age, the association is stronger with the age group under 24 (p < 0.0005) than the age group of 25-39 (p < 0.005). An association was found between the age group under 15 (p < 0.005), the type of health facility used (p < 0.0005), the distance traveled to health facilities (p < 0.005) and households' individuals' health expenditure. CONCLUSION Specific policies are needed to enhance geographical access to healthcare, financial access to and satisfaction with healthcare in moving towards universal health coverage (UHC).
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Affiliation(s)
- Hilaire Zon
- National Laboratory of Public Health, Ministry of Health, PO Box 6753, Ouagadougou, Burkina Faso.
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Naz L, Ghimire U, Zainab A. Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey. BMC Geriatr 2021; 21:42. [PMID: 33435874 PMCID: PMC7802143 DOI: 10.1186/s12877-021-02005-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population. METHODS This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson's Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital. RESULTS Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital. CONCLUSIONS Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.
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Affiliation(s)
- Lubna Naz
- Department of Economics, University of Karachi, Karachi, 75270, Pakistan
| | - Umesh Ghimire
- New ERA, Rudramati Marga, Bagmati, Kalopul, Kathmandu, 44600, Nepal.
| | - Abida Zainab
- Poverty Alleviation and Social Safety Division, Centre for Social Entrepreneurship, Islamabad, 46000, Pakistan
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Agyemang-Duah W, Peprah C, Arthur-Holmes F. Predictors of healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana. BMC Geriatr 2020; 20:79. [PMID: 32106834 PMCID: PMC7045420 DOI: 10.1186/s12877-020-1473-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Like many other low- and middle-income countries (LMICs), the Ghanaian healthcare system remains poor which is likely to affect the utilisation of healthcare services, especially among poor older people who are faced with multiple health problems. Yet, factors that explain healthcare use among poor older people in LMICs, particularly Ghana remain largely unexplored. Understanding the predictors of healthcare use among poor older people could have a huge impact on health policies in LMICs including Ghana. This study, therefore, examined factors associated with healthcare use among poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme in the Atwima Nwabiagya District of Ghana. METHODS Cross-sectional data were obtained from an Ageing, Health, Lifestyle and Health Services (AHLHS) study conducted between 1 and 20 June 2018 (N = 200) in Atwima Nwabiagya District, Ghana. Sequential logistic regression models were performed to estimate the variables that predict healthcare use among poor older people. All test results were considered significant at 0.05 or less. RESULTS The fully adjusted model showed that respondents aged 85-89 years (AOR = 0.094, CI: 0.007-1.170), acquired basic education (AOR =0.251, CI: 0.085-0.987), received no family support (AOR = 0.771, CI: 0.120-0.620), with no past illness records (AOR = 0.236, CI: 0.057-0.197) and who were not diagnosed of chronic non-communicable diseases (AOR = 0.418, CI: 0.101-0.723) were significantly less likely to utilise health facility compared with their respective counterparts. Moreover, those with no disability (AOR = 19.245, CI: 2.415-29.921) and who consumed low fruits (AOR = 1.435 = CI: 0.552-8.740) and vegetables (AOR = 1.202 = CI: 0.362-10.20) had a higher likelihood to use healthcare. CONCLUSION The study has outlined multiple factors influencing utilisation of healthcare among poor older people under the LEAP programme in Ghana. The results, therefore, validate the importance of social and behavioural determinants of healthcare use in the Ghanaian poor older population. We highlight the need for health planners and stakeholders to consider demographic, socio-economic, health-related and lifestyle factors when formulating health policy for poor older people in Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Peprah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Ayanore MA, Pavlova M, Kugbey N, Fusheini A, Tetteh J, Ayanore AA, Akazili J, Adongo PB, Groot W. Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana. Health Econ Rev 2019; 9:39. [PMID: 31885056 PMCID: PMC6935470 DOI: 10.1186/s13561-019-0255-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ghana's National Health Insurance Scheme has improved access to care, although equity and sustainability issues remain. This study examined health insurance coverage, type of payment for health insurance and reasons for being uninsured under the National Health Insurance Scheme in Ghana. METHODS The 2014 Ghana Demographic Health Survey datasets with information for 9396 women and 3855 men were analyzed. The study employed cross-sectional national representative data. The frequency distribution of socio-demographics and health insurance coverage differentials among men and women is first presented. Further statistical analysis applies a two-stage probit Hackman selection model to determine socio-demographic factors associated with type of payment for insurance and reasons for not insured among men and women under the National Health insurance Scheme in Ghana. The selection equation in the Hackman selection model also shows the association between insurance status and socio-demographic factors. RESULTS About 66.0% of women and 52.6% of men were covered by health insurance. Wealth status determined insurance status, with poorest, poorer and middle-income groups being less likely to pay themselves for insurance. Women never in union and widowed women were less likely to be covered relative to married women although this group was more likely to pay NHIS premiums themselves. Wealth status (poorest, poorer and middle-income) was associated with non-affordability as a reason for being not insured. Geographic disparities were also found. Rural men and nulliparous women were also more likely to mention no need of insurance as a reason of being uninsured. CONCLUSION Tailored policies to reduce delays in membership enrolment, improve positive perceptions and awareness of National Health Insurance Scheme in reducing catastrophic spending and addressing financial barriers for enrolment among some groups can be positive precursors to improve trust and enrolments and address broad equity concerns regarding the National Health Insurance Scheme.
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Affiliation(s)
- Martin Amogre Ayanore
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - James Akazili
- Ghana Health Service Research Division, Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioral Science, School of Public Health, University of Ghana, Accra, Ghana
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Lartey ST, de Graaff B, Magnussen CG, Boateng GO, Aikins M, Minicuci N, Kowal P, Si L, Palmer AJ. Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana. Health Policy Plan 2019; 35:199-209. [DOI: 10.1093/heapol/czz147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and <30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.
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Affiliation(s)
- Stella T Lartey
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku FI-20014, Finland
| | - Godfred O Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Moses Aikins
- School of Public Health, University of Ghana, Accra LG 13, Ghana
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani, 2 35128 Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Avenue Appia 20, 1211 Genève, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales 2305, Australia
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Kensington, NSW 2042, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3053, Australia
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Agyemang-Duah W, Peprah C, Peprah P. Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana. BMC Public Health 2019; 19:1185. [PMID: 31462254 PMCID: PMC6714403 DOI: 10.1186/s12889-019-7437-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana. METHODS Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach. RESULTS Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers). CONCLUSIONS Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Peprah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Peprah
- Natural and Built Environment, Sheffield Hallam University, Sheffield, UK
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Agyemang-Duah W, Peprah C, Arthur-Holmes F. Prevalence and Patterns of Health Care Use Among Poor Older People Under the Livelihood Empowerment Against Poverty Program in the Atwima Nwabiagya District of Ghana. Gerontol Geriatr Med 2019; 5:2333721419855455. [PMID: 31263740 PMCID: PMC6595647 DOI: 10.1177/2333721419855455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 01/11/2023] Open
Abstract
In spite of the growing literature on prevalence and patterns of health care use in later life globally, studies have generally overlooked subjective standpoints of vulnerable Ghanaian older people obstructing the achievement of the United Nations’ health-related Sustainable Development Goals. We examined the prevalence and patterns of health care use among poor older people in the Atwima Nwabiagya District of Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted between June 1 and 20, 2018 (N = 200). Chi-square and Fisher’s exact tests were carried out to estimate the differences between gender and health care utilization with significant level of less than or equal to 0.05. Whereas, 85% of the respondents utilized health care, females were higher utilizers (88% vs. 75%) but males significantly incurred higher health care expenditure. The majority utilized health services on monthly basis (38%) and consulted public health care providers (77%). While 68% utilized services from hospitals, most sourced health information from family members (54%) and financed their health care through personal income (45%). The study found that the Livelihood Empowerment Against Poverty grant played a little role in reducing health poverty. Stakeholders should review social programs that target poor older people in order to improve their well-being and utilization of health care.
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Affiliation(s)
| | - Charles Peprah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Francis Arthur-Holmes
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,Department of International Development, University of Oxford, Oxford, UK
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Fonta CL, Nonvignon J, Aikins M, Nonvignon J, Aryeetey GC. Economic Analysis of Health Inequality Among the Elderly in Ghana. Population Ageing 2020; 13:113-27. [DOI: 10.1007/s12062-019-09245-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chatterjee C, Nayak NC, Mahakud J, Chatterjee SC. Factors affecting the choice of health care utilisation between private and public services among the elderly population in India. Int J Health Plann Manage 2018; 34:e736-e751. [PMID: 30378705 DOI: 10.1002/hpm.2686] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 11/06/2022] Open
Abstract
India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.
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Affiliation(s)
- Chandrima Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Narayan Chandra Nayak
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Jitendra Mahakud
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Suhita Chopra Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
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Abstract
BACKGROUND There are not many studies evaluating the factors affecting medical expenditure for different age groups, income classes, and subjective social classes. Therefore, this study evaluates the agreement between income class, objective class, and subjective social class and analyzes the factors that affect medical expenditure by age group. METHODS Multiple regression analysis and χ test were conducted to evaluate the compatibility between income quintiles and subjective social classes and to identify the factors influencing medical expenditure by subjective social class and age using raw data from the 2013 Korea Health Panel (n = 9,385) of the Korea Institute for Health and Social Affairs and the National Health Insurance Service. RESULTS When the class compatibility between income quintiles and subjective social classes was analyzed by age group, young people in the first, second, and third income quintiles considered themselves to be in the second subjective social class while and those in the fourth and fifth income quintiles considered themselves to be in the third subjective social class. Moreover, middle-aged and old people in the first, second, third, and fourth income quintile considered themselves to be in the second subjective social class while those in the fifth income quintile considered themselves to be in the third subjective social class. CONCLUSION Social support, public health approaches, and medical treatment service models are needed to eliminate comparative deprivation among individuals.
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Affiliation(s)
- Ryoung Choi
- Department of Health Administration, Dongshin University, Naju
| | - Hyun Goo Kang
- Department of Neurology, Chosun University Hospital, Gwangju
- Department of Neurology, Chonbuk National University Hospital, Jeonju, South Korea
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Dei V, Sebastian MS. Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians. Int J Equity Health 2018; 17:86. [PMID: 29925401 PMCID: PMC6011249 DOI: 10.1186/s12939-018-0791-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There 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. METHODS This 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. RESULTS Horizontal 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. CONCLUSION Whilst 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.
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Affiliation(s)
- Vincent Dei
- International SOS, Ghana, No. 2 Mankata Close Link, Airport Residential Area, Accra, Ghana
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, SE-901 85 Umea, Sweden
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