The role of a health protection scheme in health services utilisation among community-dwelling older persons in Ghana.

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

Methods: Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behaviour Study collected between August 2016 and January 2017 (N = 1200). Descriptive and bivariate analyses described the sample. Generalised Poisson and logit regression models respectively estimated the predictors of frequency of health services utilisation and time from onset of illness to health facility use and during last illness episode.

Results: Older persons with active NHIS membership frequently used health facilities (β = 0.237, SE = 0.0957, p ˂ 0.005), 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 ˂ 0.001) compared with non-enrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eβ = 2.149, SE = 0.240, p ˂ 0.005), social support recipients (eβ = 1.366, SE = 0.162, p ˂ 0.05) and those living with relevant others (eβ = 2.699, SE = 0.175, p ˂ 0.001) were more likely to consume health services.

Discussion: Ghana's NHIS policy generally increases health services utilisation but at present lacks the capability to improve equitable access to healthcare, especially between poor and non-poor older adults. This may hamper the progress towards universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.