Abstract
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.
Highlights
Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services
Higher education and higher wealth were associated with the use of private outpatient healthcare services
This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; health insurance was a predictor only for the use of public facilities
Summary
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. Healthcare utilization; health system responsiveness; older adults; WHO-SAGE; Ghana delivery systems. As people age, they are more likely to need healthcare due to declining functional capacity and the increased likelihood of having more complex health problems. Prior studies have reported the factors associated with healthcare utilization by older adults [8,9,10], including having multiple chronic conditions [11,12,13], high level of education [13], living alone, poor self-perceived health [14], older age, higher income, access to health insurance [12,15]
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