Informal payments and willingness to pay informally for health care among older adults: equity perspectives for geriatric care in Ghana

Martin Amogre Ayanore, Robert Asampong, Robert Kaba Alhassan, Phidelia Doegah, Evelyn Acquah, Nuworza Kugbey, Matilda Aberese-Ako, Derrick Mensah, Peter Adatara, Francis Zotor, James Akazili

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Out-of-Pocket (OOP) payment is one mechanism for funding health care in low- and middle-income countries (LMICs). The wider implications mean OOP payments have the potential to increase, with catastrophic effects for a vulnerable population group such as older adults. This study aimed to determine the prevalence of informal patient payments (IPPs) and willingness and ability to pay informally, and its associated factors among older adults in Ghana.

We conducted a community-based cross-sectional study to collect data among 462 older adults (60+ years) across three municipal areas in the Volta Region of Ghana. Data were collected using an interviewer-administered semi-structured questionnaire. Binary logistic regression was performed to identify factors associated with IPP. The significance level was set at P < 0.05.

The prevalence of IPP was 21.2%. About 64.5% of respondents were willing to make IPP if they had good financial standing. Factors significantly associated with IPP were age (75 years and above) (odds ratios [OR], 1.76; 95% confidence interval [CI], 1.37–2.26), being uninsured (OR, 1.68; 95% CI, 1.48–1.91), having a urinary health problem (OR, 2.49; 95% CI, 1.56–3.97), and having a stronger preference for private healthcare facilities (OR, 1.35; 95% CI, 1.26–1.44). Not having a chronic condition (OR, 0.59; 95% CI, 0.41–0.83) and unwillingness to make IPP (OR, 0.48; 95% CI, 0.26–0.87) were associated with lower odds of IPP.

The existence IPP reflects important inequity gaps within the formal healthcare system and requires urgent sustainable policy actions to protect economically vulnerable older adults from financial catastrophe. We recommend measures of informal payments and “perceived corruption” in the health system be included in the Ghana Living Standard Surveys and Demographic Health Surveys to inform future policy decisions in this area.
Original languageEnglish
Article numbere7
Number of pages15
JournalJournal of Global Health Science
Issue number1
Publication statusPublished - Jun 2023


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