Income-related inequalities in health care utilization among old adults in six LMICs: China, Ghana, India, Mexico, Russian and South Africa

Abstract

Common and long-running concern across the world relates to the impact of increasing population aging on health care utilization and more evidence about the inequality in health care utilization by older adults in low- and middle-income countries (LMICs) is necessary for assessing the capacity of health care systems in LMICs to align with the universal health coverage agenda. In this paper, using data from WHO Study on Global Ageing and adult health (SAGE) in China, Ghana, India, Mexico, Russian Federation and South Africa, the multi-national magnitude in inequality of health care use is measured by concentration index in each country. The results show that a pro-rich inequality in health care utilization existed: China Mexico and Ghana show up with a high degree of inequality in outpatient service utilization; most of the countries show up with a low level of inequality for inpatient service (except China). Then especially India, but also Ghana, South Africa, and China, show up with a high degree of inequality and inequity in chronic diseases service utilization. However, there doesn’t appear to be one system characteristic of inequality in health care utilization since these six countries all have very diverse characteristics with different stages of the demographic and epidemiological transitions. The decomposition shows that income itself is the most important but not the only driving factor. And the distribution of education, health insurance, and urban/rural residents are the prime other contributors to health inequality. Also, this paper shows that inequalities for non-communicative diseases service utilization in LMICs produce big challenges, which underlines the role of prevention and health promotion throughout the life course to help reduce the burden due to non-communicable diseases. This paper provides a number of new insights on population aging’s impact on health care utilization in low- and middle-income countries.