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Background Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana. Methods Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach. Results Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers). Conclusions Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana. Electronic supplementary material The online version of this article (10.1186/s12889-019-7437-2) contains supplementary material, which is available to authorized users.

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Background Older people utilise more healthcare services and are likely to incur higher healthcare expenditure, however, data on their healthcare financing mechanisms are scarce in low-and middle- income countries including Ghana. In this study, we aimed at exploring how poor older people finance their healthcare in rural Ghana. Methods We conducted in-depth interviews and focus group discussions with 60 study participants comprising 30 poor older people, 15 healthcare providers and 15 caregivers in Atwima Nwabiagya District of Ghana. Data were analysed using thematic analytical framework and presented based on an a posteriori inductive reduction approach. Results The study revealed that poor older people finance their healthcare through personal income, family support, Livelihood Empowerment Against Poverty grants and National Health Insurance Scheme subscription. It was also found that poor older people spent between GH¢ 20 and 250 on drugs, laboratory test and hospitalisation anytime they access a healthcare facility. Conclusion The findings contribute to our understanding of how poor older people finance their healthcare in rural Ghana. We argue that health stakeholders should strengthen healthcare financing mechanisms for poor older people for optimal healthcare use.

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