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Archives of Public Health
Published in: Archives of Public Health 1/2023

Open Access 01-12-2023 | Research

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

Authors: Williams Agyemang-Duah, Dennis Asante, Joseph Oduro Appiah, Anthony Kwame Morgan, Isaac Verberk Mensah, Prince Peprah, Anthony Acquah Mensah

Published in: Archives of Public Health | Issue 1/2023

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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.
Literature
1.
Lutz W, Sanderson W, Scherbov S. The coming acceleration of global population ageing. Nature. 2008;451(7179):716–9.PubMedCrossRef
2.
United Nations. (2017). World population ageing 2017 (ST/ESA/SER.A/408): Department of Economic and Social Affairs, Population Division, United Nations; 2017.
3.
Mba JC. (2010). Population ageing in Ghana Research gaps and the way forward. Journal of Aging Research, 2010, 1–8.
4.
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. 2019b;19(1):1–12.CrossRef
5.
Palangkaraya A, Yong J. Population ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries. Int J Health Care Finance Econ. 2009;9(4):391–402.PubMedCrossRef
6.
Asante D, McLachlan CS, Isaac V. (2021). The Prevalence of Chronic Physical and Mental Health Conditions in Older Adults Across South Australia and Their Independent Effects on General Practitioner Visits.Journal of Applied Gerontology,07334648211049709.
7.
Thiébaut SP, Barnay T, Ventelou B. Ageing, chronic conditions and the evolution of future drugs expenditure: a five-year micro-simulation from 2004 to 2029. Appl Econ. 2013;45(13):1663–72.CrossRef
8.
Gyasi RM, Phillips DR, Amoah PA. Multidimensional social support and health services utilization among noninstitutionalized older persons in Ghana. J Aging Health. 2020a;32(3–4):227–39.PubMedCrossRef
9.
Gyasi RM, Adam AM, Phillips DR. Financial inclusion, Health-Seeking behavior, and health outcomes among older adults in Ghana. Res Aging. 2019;41(8):794–820.PubMedCrossRef
10.
Gong CH, Kendig H, He X. Factors predicting health services use among older people in China: an analysis of the China Health and Retirement Longitudinal Study 2013. BMC Health Serv Res. 2016;16(1):1–16.CrossRef
11.
Awoke MA, Negin J, Moller J, Farell P, Yawson AE, Biritwum RB, Kowal P. Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana. Global Health Action. 2017;10(1):1301723.PubMedPubMedCentralCrossRef
12.
Breyer F, Costa-Font J, Felder S. Ageing, health, and health care. Oxf Rev Econ Policy. 2010;26(4):674–90.CrossRef
13.
Ambagtsheer RC, Moussa RK. Association of frailty with health service utilisation and health care expenditure in sub-saharan Africa: evidence from Côte d’Ivoire. BMC Geriatr. 2021;21:1–12.CrossRef
14.
Huang H, Menezes PR, Silva D, Tabb SA, Barkil-Oteo K, A., Scazufca M. The association between depressive disorders and health care utilization: results from the São Paulo ageing and health study (SPAH). Gen Hosp Psychiatry. 2014;36(2):199–202.PubMedCrossRef
15.
Himelhoch S, Weller WE, Wu AW, Anderson GF, Cooper LA. (2004). Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries.Medical Care,512–521.
16.
Adler NE, Glymour MM, Fielding J. Addressing social determinants of health and health inequalities. JAMA. 2016;316(16):1641–2.PubMedCrossRef
17.
Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh WP, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res. 2021;21(1):1–11.CrossRef
18.
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. Archives of Public Health. 2021;79(1):1–11.CrossRef
19.
Muhammad T, Balachandran A, Srivastava S. (2021). Socio-economic and health determinants of preference for separate living among older adults: a cross-sectional study in India.PLoS One, 16(4), e0249828.
20.
Brinda EM, Attermann J, Gerdtham UG, Enemark U. Socio-economic inequalities in health and health service use among older adults in India: results from the WHO Study on Global AGEing and adult health survey. Public Health. 2016;141:32–41.PubMedCrossRef
21.
22.
Park S, Kim B, Kim S. Poverty and working status in changes of unmet health care need in old age. Health Policy. 2016;120(6):638–45.PubMedCrossRef
23.
Busse R, Blümel M, World Health Organization. &. (2014). Germany:health system review.
24.
Fisher, K. A., Griffith, L. E., Gruneir, A., Upshur, R., Perez, R., Favotto, L., …Ploeg, J. (2021). Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data. BMC health services research, 21(1), 1–17.
25.
Tzeng HM, Okpalauwaekwe U, Li CY. Older adults’ socio-demographic determinants of health related to promoting health and getting preventive health care in southern United States: a secondary analysis of a survey project dataSET. Nurs Rep. 2021;11(1):120–32.PubMedPubMedCentralCrossRef
26.
27.
Button P, Dils E, Harrell B, Fumarco L, Schwegman D. Gender identity, race, and ethnicity discrimination in access to mental health care: preliminary evidence from a multi-wave audit field experiment. No. w28164. National Bureau of Economic Research; 2020.
28.
Hoebel J, Rattay P, Prütz F, Rommel A, Lampert T. (2016). Socioeconomic status and use of outpatient medical care: the case of Germany.PloS one, 11(5), e0155982.
29.
30.
Agyemang-Duah W, Owusu-Ansah JK, Peprah C. Factors influencing healthcare use among poor older females under the livelihood empowerment against poverty programme in Atwima Nwabiagya District, Ghana. BMC Res Notes. 2019a;12(1):1–6.CrossRef
31.
Saeed BI, Xicang Z, Yawson AE, Nguah SB, Nsowah-Nuamah NN. Impact of socioeconomic status and medical conditions on health and healthcare utilization among aging Ghanaians. BMC Public Health. 2015;15(1):1–9.CrossRef
32.
Kim HK, Lee M. Factors associated with health services utilization between the years 2010 and 2012 in Korea: using Andersen’s behavioral model. Osong Public Health and Research Perspectives. 2016;7(1):18–25.PubMedCrossRef
33.
Ameh S, Gómez-Olivé FX, Kahn K, Tollman SM, Klipstein-Grobusch K. Predictors of health care use by adults 50 years and over in a rural south african setting. Global Health Action. 2014;7(1):24771.PubMedCrossRef
34.
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 Geriatric Med. 2019b;5:2333721419855455.CrossRef
35.
Van Der Wielen N, Channon AA, Falkingham J. (2018). Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana.BMJ global health, 3(1), e000590.
36.
Singh S, Patra S, Khan AM. Health care services: utilization and perception among elderly in an urban resettlement colony of Delhi. J Family Med Prim Care. 2022;11(4):1468.PubMedPubMedCentralCrossRef
37.
Agyemang-Duah W, Adei D, Oduro Appiah J, Peprah P, Fordjour AA, Peprah V, Peprah C. Communication barriers to formal healthcare utilisation and associated factors among poor older people in Ghana. J Communication Healthc. 2021;14(3):216–24.CrossRef
38.
Dadjo J, Ahinkorah BO, Yaya S. Health insurance coverage and antenatal care services utilization in West Africa. BMC Health Serv Res. 2022;22(1):1–9.CrossRef
39.
Zhou S, Huang T, Li A, Wang Z. Does universal health insurance coverage reduce unmet healthcare needs in China? Evidence from the National Health Service Survey. Int J Equity Health. 2021;20(1):1–17.CrossRef
40.
Jaramillo ET, Sommerfeld DH, Lujan E, Willging CE. Using concept mapping to understand gender-and age-specific factors influencing health care access among american indian Elders. Am Indian Alaska Nativ Mental Health Res (Online). 2021;28(2):52.CrossRef
41.
Gyasi RM, Phillips DR. Gender, self-rated health and functional decline among community-dwelling older adults. Arch Gerontol Geriatr. 2018;77:174–83.PubMedCrossRef
42.
WHO. Country statistics and global health estimates by WHO and UN partner. Geneva: World Health Organization; 2015.
43.
Van Rooy G, Mufune P, Amadhila E. Experiences and perceptions of barriers to health services for elderly in rural Namibia: a qualitative study. SAGE Open. 2015;5(3):2158244015596049.
44.
Brüne, M., Linnenkamp, U., Andrich, S., Jaffan-Kolb, L., Claessen, H., Dintsios, C.M., … Icks, A. (2021). Health care use and costs in individuals with diabetes with and without comorbid depression in Germany: results of the cross-sectional DiaDEc study. Diabetes Care, 44(2), 407–415.
45.
Ameyaw EK, Ahinkorah BO, Baatiema L, Seidu AA. Is the National Health Insurance Scheme helping pregnant women in accessing health services? Analysis of the 2014 Ghana demographic and Health survey. BMC Pregnancy Childbirth. 2021;21(1):1–8.CrossRef
46.
Guindon GE, Fatima T, Garasia S, Khoee K. A systematic umbrella review of the association of prescription drug insurance and cost-sharing with drug use, health services use, and health. BMC Health Serv Res. 2022;22(1):1–33.CrossRef
47.
Gyasi RM, Phillips DR, Buor D. The role of a health protection scheme in health services utilization among community-dwelling older persons in Ghana. The Journals of Gerontology: Series B. 2020;75(3):661–73.
48.
Kpoor A. Household maintenance and decision making in lone female parent families in Ghana. J Fam Issues. 2014;35(14):1959–79.CrossRef
49.
Ganle JK, Obeng B, Segbefia AY, Mwinyuri V, Yeboah JY, Baatiema L. How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study. BMC Pregnancy Childbirth. 2015;15(1):1–17.CrossRef
50.
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(1):1–11.CrossRef
51.
Sabety AH, Jena AB, Barnett ML. Changes in health care use and outcomes after turnover in primary care. JAMA Intern Med. 2021;181(2):186–94.PubMedCrossRef
52.
Jetty A, Jabbarpour Y, Pollack J, Huerto R, Woo S, Petterson S. Patient-physician racial concordance associated with improved healthcare use and lower healthcare expenditures in minority populations. J Racial Ethnic Health Disparities. 2022;9(1):68–81.CrossRef
53.
Kreps GL, Bonaguro EW. (2009). Health communication as applied communication inquiry. Routledge Handbook of Applied Communication Research (pp. 420–444).Routledge.
54.
Gracey, C. F., Haidet, P., Branch, W. T., Weissmann, P., Kern, D. E., Mitchell, G.,… Inui, T. (2005). Precepting humanism: strategies for fostering the human dimensions of care in ambulatory settings. Academic Medicine, 80(1), 21–28.
55.
Pel-Littel, R. E., Snaterse, M., Teppich, N. M., Buurman, B. M., van Etten-Jamaludin,F. S., van Weert, J., … Scholte op Reimer, W. J. (2021). Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review. BMC Geriatrics, 21(1), 1–14.
56.
Branch Jr, W. T., Frankel, R., Gracey, C. F., Haidet, P. M., Weissmann, P. F., Cantey,P., … Inui, T. S. (2009). A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Academic Medicine, 84(1), 117–125.
57.
Rider EA, Keefer CH. Communication skills competencies: definitions and a teaching toolbox. Med Educ. 2006;40(7):624–9.PubMedCrossRef
58.
Rider EA. Advanced communication strategies for relationship-centered care. Pediatr Ann. 2011;40(9):447–53.PubMedCrossRef
59.
Rider EA. Competency I: interpersonal and communication skills. In: Rider EA, Nawotniak RH, Smith GD, editors. A practical guide to teaching and assessing the ACGME Core Competencies. Marblehead, MA, USA: HCPro, Inc; 2007.
60.
Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: an integrative review. Nurse Educ Pract. 2016;19:36–40.PubMedCrossRef
61.
Croucher SM, editor. Global perspectives on intercultural communication. Taylor & Francis; 2017.
62.
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(1):1–12.CrossRef
63.
Bhan N, Madhira P, Muralidharan A, Kulkarni B, Murthy GVS, Basu S, Kinra S. Health needs, access to healthcare, and perceptions of ageing in an urbanizing community in India: a qualitative study. BMC Geriatr. 2017;17(1):1–11.CrossRef
64.
Aboderin IA, Beard JR. Older people’s health in sub-saharan Africa. The Lancet. 2015;385(9968):e9–e11.CrossRef
65.
Luque Ramos A, Hoffmann F, Spreckelsen O. Waiting times in primary care depending on insurance scheme in Germany. BMC Health Serv Res. 2018;18(1):1–9.CrossRef
66.
Adei D, Mensah AA, Agyemang-Duah W, Aboagye-Gyasi L. Factors associated with health-seeking behaviour among informal sector workers in the Kumasi metropolis of Ghana. Cogent Public Health. 2022;9(1):2103932.CrossRef
67.
Biya M, Gezahagn M, Birhanu B, Yitbarek K, Getachew N, Beyene W. Waiting time and its associated factors in patients presenting to outpatient departments at Public Hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Serv Res. 2022;22(1):107.PubMedPubMedCentralCrossRef
Metadata
Title
System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana
Authors
Williams Agyemang-Duah
Dennis Asante
Joseph Oduro Appiah
Anthony Kwame Morgan
Isaac Verberk Mensah
Prince Peprah
Anthony Acquah Mensah
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Archives of Public Health / Issue 1/2023
Electronic ISSN: 2049-3258
DOI
https://doi.org/10.1186/s13690-023-01063-w

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