The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana

Razak M GYASI, David R PHILLIPS, Daniel BUOR

Research output: Journal PublicationsJournal Article (refereed)

10 Citations (Scopus)


Objectives: This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and “timing” of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life.

Methods: Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses
described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness

Results: Older persons with active NHIS membership frequently used health facilities (β = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more
likely to attend health facility earlier (β = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eβ = 2.149, SE = 0.240, p ˂ .005), social support recipients (eβ = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eβ = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services.

Discussion: Ghana’s NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.
Original languageEnglish
Article numbergby082
Pages (from-to)661-673
Number of pages13
JournalJournals of Gerontology - Series B Psychological Sciences and Social Sciences
Issue number3
Early online date2 Jul 2018
Publication statusPublished - 14 Feb 2020

Bibliographical note

This work was supported by Lingnan University, Hong Kong [RPG 1129310]. The sponsor played no role in the design, execution, analysis and interpretation of data, and preparation of the article.

Ethical Considerations: Human Subject Certification was obtained before interviews began. This study was approved by the Committee on Human Research Publication and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana (Ref: CHRPE/AP/507/16). Ethics approval was also granted by the Research Ethics Sub-Committee of Lingnan University Hong Kong. Study participants were fully briefed on the research and gave written and/or verbal informed consent. Author contributions: R. M. Gyasi conceived and designed the study under the PhD supervision of D. R. Phillips. R. M. Gyasi supervised the fieldwork, analyzed the data, and wrote the initial version of the article. D. R. Phillips and D. Buor undertook critical review and revision of the article. All authors read and approved the final article


  • Ghana
  • Health services utilization
  • National Health Insurance Scheme
  • Older persons
  • Social policies
  • Universal health coverage (UHC)

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