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

ABSTRACT

Background: Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services. The present study examined factors associated with public and private healthcare service use, and the resulting perceived health system responsiveness.

Objectives: To identify factors associated with public and private healthcare utilization among older adults aged 50 and older in Ghana; and to compare perceived differences in health system responsiveness between the private and public sectors.

Methods: Cross-sectional data was analyzed from the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 in Ghana. Using Andersen’s conceptual framework, public and private outpatient care utilization was examined using multinomial logistic regression to estimate and identify predictor variables associated with the type of outpatient healthcare facility accessed. Health system responsiveness was compared using chi-square tests.

Results: Of 2517 respondents who used outpatient care in the 12 months preceding interview, 51.7% of respondents used a public facility, 17.8% a private facility, and 30.5% used other facilities. Older age group, higher education and higher wealth were associated with the use of private outpatient healthcare services. Using public outpatient care facilities was associated with having health insurance. Respondents with two or more chronic conditions were more likely to use public and private outpatient care than other facilities. Perceived health system responsiveness was better in private for-profit than in public and private not-for-profit healthcare facilities.

Conclusions: This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; however, health insurance was a predictor only for the use of public facilities. Future mixed-method studies could further elucidate factors influencing the choice of public and private outpatient healthcare use.

KEYWORDS:

• Healthcare utilization
• health system responsiveness
• older adults
• WHO-SAGE
• Ghana

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

We thank the respondents for participating and are grateful for the expertise of the survey team.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The WHO Ethical Review Committee approved SAGE Wave 1. In addition, the SAGE Ghana team obtained clearance from the Ethical and Protocol Review Committee of the University of Ghana Medical School. Written informed consent was obtained from all respondents.

Paper context

Understanding what drives utilization of health services is critical to achieving Universal Health Coverage. This study examined factors associated with utilization of public and private healthcare services by older adults in Ghana as well as health system responsiveness. Wealth was found to be a major driver of utilization and private services were found to be more responsive than public which identifies areas for policy-makers to build on to improve coverage and quality.

Additional information

Funding

SAGE was supported by the US National Institute on Aging through an interagency agreement with the WHO (OGHA 04034785, YA1323-08-CN-0020, Y1-AG-1005-01) [grant nos. R01AG034479 and R21AG034263]. The WHO contributed financial and human resources to SAGE Wave 1. The University of Ghana Medical School provided financial and in-kind support to the SAGE Ghana team.

Notes on contributors

Mamaru Ayenew Awoke

Joel Negin and Paul Kowal conceived the idea of this paper, as part of a set of initial publications for SAGE Wave 1. Mamaru Ayenew Awoke has done statistical analyses and drafted the initial paper. Jette Moller and Joel Negin have been involved throughout the paper development and reviewed the paper at each stage. Paul Kowal critically reviewed the paper and made ready the final manuscript. Penny Farell managed the editing and finalization of the manuscript with input from Alfred E. Yawson, Richard Berko Biritwum and Paul Kowal. All authors contributed to the final manuscript and have read and approved the final manuscript.