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

Figures & data

Table 1. Distribution of demographic, socioeconomic and health characteristics, by the type of healthcare facility used, SAGE Ghana Wave 1 2007/08.

	Type of health facility
	Private		Public		Others^a
Variable	n	%	n	%	n	%	F	p-value
Age group
50–59	134	32.4	450	35.1	312	40.0	1.3	0.262
60–69	122	29.3	362	28.2	219	27.5
70–79	108	27.8	355	26.1	168	21.0
80+	38	10.6	148	10.6	101	11.6
Sex
Male	188	51.5	611	46.8	404	49.4	1.6	0.208
Female	214	48.5	704	53.2	396	50.6
Residence
Urban	220	52.9	623	46.8	529	67.9	8.9	< 0.001
Rural	182	47.1	692	53.2	271	32.1
Educational status
No formal education	163	35.9	683	50.1	435	53.5	4.5	< 0.001
Primary completed or less	99	26.3	268	20.9	179	21.8
Secondary school completed	28	6.5	71	5.6	21	3.0
High school and above	111	31.3	290	23.4	164	21.7
Marital status
Never married	3	0.8	15	1.3	10	1.2	0.9	0.441
Currently married/cohabitating	223	62.4	697	56.3	429	57.7
Separated/widowed	174	36.9	598	42.5	360	41.2
Wealth quintile
Q1 (poorest)	48	9.1	172	12.1	170	21.2	10.5	< 0.001
Q2	53	15.2	233	16.6	184	21.7
Q3	75	19.2	255	20.7	198	25.3
Q4	84	20.0	325	24.5	138	18.1
Q5 (richest)	140	36.6	329	26.2	109	13.7
Health insurance
Yes	185	44.1	721	53.3	255	33.2	21.6	< 0.001
No	217	56.0	594	46.7	545	66.8
Type of job employment
Public sector	39	9.9	170	14.0	53	7.3	4.1	< 0.001
Private sector	18	3.9	48	4.1	25	3.3
Self-employed	316	81.7	991	75.1	680	85.0
Informal employment	19	4.5	84	6.9	35	4.4
Chronic health conditions
None	89	21.3	366	27.2	244	29.1	5.7	< 0.001
One chronic condition	208	52.0	635	50.0	445	56.8
Two or more chronic conditions	103	26.8	298	22.7	108	14.1
Self-rated health
Good/very good	172	42.4	451	35.2	265	32.7	2.8	0.030
Moderate	161	40.5	609	45.2	349	42.8
Bad/very bad	69	17.1	255	19.6	186	24.4

Notes: N: unweighted; % (percent): the weighted proportions.

Other services include charity clinic, charity hospital, home visits and other.

Table 2. Odds ratios from multinomial logistic regression models of predisposing, enabling and need factors associated with outpatient public and private healthcare utilization, SAGE Ghana Wave 1, 2007/08.

	Model 1		Model 2		Model 3
	Private vs. others^a	Public vs. others^a	Private vs. others^a	Public vs. others^a	Private vs. others^a	Public vs. others^a
Predictor	OR (95% CIs)	OR (95% CIs)	OR (95% CIs)	OR (95% CIs)	OR (95% CIs)	OR (95% CIs)
Age group
50–59	1	1	1		1	1
60–69	1.58 (1.1–2.25)	1.24 (0.94–1.65)	1.49 (1.04–2.14)	1.09 (0.81–1.46)	1.56 (1.08–2.25)	1.09 (0.81–1.48)
70–79	2.30 (1.43–3.7)	1.59 (1.18–2.1)	2.13 (1.3–3.5)	1.23 (0.91–1.66)	2.17 (1.34–3.52)	1.24 (0.91–1.69)
80+	1.91 (1.07–3.38)	1.24 (0.84–1.83)	1.72 (0.96–3.08)	1.01 (0.68–1.49)	1.94 (1.08–3.46)	1.03 (0.70–1.55)
Sex
Male	1	1	1	1
Female	1.31 (0.96–1.8)	1.29 (1.04–1.61)	1.28 (0.91–1.80)	1.29 (1.01–1.65)	1.26 (0.89–1.79)	1.28 (1.0–1.63)
Educational level
No formal education	1	1	1	1	1	1
Primary completed or less	2.26 (1.54–3.33)	1.16 (0.88–1.54)	1.96 (1.29–2.97)	0.97 (0.73–1.27)	1.87 (1.22–2.87)	0.94 (0.71–1.25)
Secondary school completed	4.53 (2.03–10.11)	2.44 (1.32–4.52)	3.01 (1.42–6.41)	1.7 (0.89–3.23)	2.91 (1.36–6.26)	1.74 (0.92–3.28)
High school and above	2.95 (1.86–4.69)	1.39 (1.03–1.88)	2.01 (1.21–3.36)	0.84 (0.60–1.18)	1.91 (1.13–3.22)	0.84 (0.60–1.19)
Residence
Rural			1	1	1	1
Urban			1.49 (0.92–2.43)	1.34 (0.91–1.96)	1.45 (0.89–2.36)	1.34 (0.91–1.98)
Wealth quintile
Q1 (lowest)			1	1	1	1
Q2			1.58 (0.94–2.65)	1.28 (0.91–1.80)	1.50 (0.88–2.53)	1.27 (0.89–1.81)
Q3			1.67 (1.05–2.65)	1.31 (0.90–1.92)	1.61 (1.01–2.57)	1.33 (0.91–1.96)
Q4			2.12 (1.29–3.48)	1.89 (1.33–2.69)	1.98 (1.21–3.23)	1.84 (1.28–2.64)
Q5 (Highest)			4.41 (2.63–7.41)	2.43 (1.55–3.82)	4.03 (2.41–6.73)	2.38 (1.50–3.77)
Health insurance
No			1	1	1	1
Yes			1.24 (0.88–1.75)	1.98 (1.51–2.59)	1.22 (0.87–1.73)	1.97 (1.51–2.57)
Type of job employment
Public sector			1	1	1	1
Private sector			0.97 (0.39–2.37)	0.66 (0.34–1.28)	0.97 (0.40–2.36)	0.66 (0.34–1.29)
Self-employed			1.61 (0.90–2.90)	0.66 (0.44–1.0)	1.66 (0.93–2.97)	0.68 (0.45–1.02)
Informal employment			1.68 (0.66–4.26)	1.12 (0.61–2.08)	1.82 (0.70–4.75)	1.21 (0.65–2.27)
Chronic health conditions
None					1	1
One chronic condition					1.13 (0.80–1.59)	0.85 (0.66–1.10)
Two or more chronic conditions					2.04 (1.29–3.22)	1.39 (1.01–1.92)
Self-rated health
Good/very good					1	1
Moderate					0.67 (0.49–0.93)	0.89 (0.68–1.17)
Bad/very bad					0.50 (0.31–0.79)	0.75 (0.55–1.01)

Note: ^aOther healthcare facility includes charity clinic, charity hospital, home visit and other.

Table 3. Health system responsiveness among older adults who received outpatient healthcare in the past 12 months, by type of facility, SAGE Ghana Wave 1, 2007/08.

	Private for-profit		Private not-for-profit		Public services
	n	%	n	%	n	%	F	p
For the last visit to a healthcare provider rate the following:
The amount of time waited before being attended to:
	(n = 396)		(n = 174)		(n = 1306)
Very good/good	288	74.1	76	45.1	782	60.7	7.7	< 0.0001
Moderate	81	20.2	57	33.5	342	24.7
Bad/very bad	26	5.7	41	21.4	182	14.6
Your experience of being treated respectfully:
	(n = 397)		(n = 175)		(n = 1325)
Very good/good	335	89.4	124	71.6	1012	78.3	5.4	0.0004
Moderate	39	9.9	47	25.9	269	19.6
Bad/very bad	3	0.7	4	2.5	25	2.1
How clearly healthcare providers explained things to you?
	(n = 397)		(n = 174)		(n = 1304)
Very good/good	326	82.1	104	61.1	894	68.9	5.9	0.0003
Moderate	56	14.9	54	29.9	308	22.8
Bad/very bad	15	3.0	16	9.0	102	8.3
Your experience in being involved in making decisions for your treatment:
	(n = 397)		(n = 174)		(n = 1303)
Very good/good	291	73.4	90	54.7	806	60.9	8.7	0.0009
Moderate	81	20.1	50	27.9	317	24.1	5.0
Bad/very bad	25	6.5	34	17.4	180	14.9
The way the health services ensured you could talk privately to health providers:
	(n = 397)		(n = 1306)		(n = 175)
Very good/good	350	88.0	126	72.4	1033	77.7	3.9	0.0091
Moderate	44	11.5	44	25	239	18.7
Bad/very bad	3	0.5	5	2.6	34	3.6
…the ease with which you could see a healthcare provider you were happy with?
	(n = 397)		(n = 175)		(n = 1307)
Very good/good	296	73.8	88	49.7	808	60	6.7	< 0.0001
Moderate	86	22.8	68	37.7	376	28.1
Bad/very bad	15	3.4	19	12.6	123	11.9
…the cleanliness in the health facility?
	(n = 397)		(n = 174)		(n = 1323)
Very good/good	376	95.8	153	89	1124	85.5	7.1	< 0.0001
Moderate	20	4.0	16	8.4	153	11.9
Bad/very bad	1	0.2	5	2.6	25	2.6

Notes: n: unweighted; percentage: weighted. Private not-for-profit: charity clinics and hospitals. The highest numbers in the column are in bold.