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 objective

The 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.

Design

Secondary 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.

Results

In 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.

Conclusions

This study provides a basis for further investigation of country-specific responses to UHC.

• health care use utilization
• low- and middle-income
• universal coverage

Authors’ contributions

PK, SC, and NN were the originators of this paper, as part of a set of initial publications for SAGE Wave 1. KP, PK, and JSW drafted the initial paper. JSW and KP undertook the statistical analyses. JSW managed the editing and finalization of the manuscript with input from JN, PK, and KP. All authors contributed to the final manuscript.

Acknowledgements

We thank the respondents in each country for their continued contributions. We are grateful for the contributions of the country primary investigators and their respective survey teams. The study on global AGEing and adult health is supported by the US National Institute on Aging's Division of Behavioral and Social Science Research (BSR) through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with WHO. Financial and/or in-kind support has come from the governments of China and South Africa (National Department of Health) to their respective national studies. The Shanghai CDC contributed financial and in-kind support for SAGE China. JSW was supported by the University of Newcastle Australia Research Centre for Gender, Health and Ageing (early development) and subsequently by Umeå Centre for Global Health Research, with support from FAS, the Swedish Council for Working Life and Social Research (Grant No. 2006-1512).

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

Financial disclosure

None of the donor agencies had a role in data collection and analysis, decision to publish, or preparation of the manuscript.