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Research article
Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: Evidence from a nationally representative survey
Umesh Ghimire
New ERA
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4246-8379
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Geriatrics.
Background
In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.
Methods
This study used a sample of 5,319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson’s Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.
Results
Out of total 5,319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.
Conclusions
Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.
Keywords
Behavioral Factors, Elderly health, Healthcare System, Social Protection Programs, Wealth Quintiles
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CURRENT STATUS: Published
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Posted 13 Jan, 2021
Published
On 12 Jan, 2021
No community comments so far
Submission checks complete
On 03 Jan, 2021
Editorial decision: Accept
On 29 Dec, 2020
No comments provided
Reviewer #1 agreed
On 10 Dec, 2020
Editor assigned
On 09 Dec, 2020
Reviewers invited
Invitations sent on 09 Dec, 2020
Submission checks complete
On 09 Dec, 2020
Editor invited
On 09 Dec, 2020
No comments provided
Review #2 received
Received 23 Nov, 2020
Editorial decision: Minor revision
On 23 Nov, 2020
Review #1 received
Received 28 Oct, 2020
Reviewer #2 agreed
On 22 Oct, 2020
Reviewer #1 agreed
On 12 Oct, 2020
Editor assigned
On 07 Oct, 2020
Reviewers invited
Invitations sent on 07 Oct, 2020
Submission checks complete
On 06 Oct, 2020
Editor invited
On 06 Oct, 2020
No comments provided
Review #2 received
Received 08 Sep, 2020
Editorial decision: Major revision
On 08 Sep, 2020
Review #1 received
Received 26 Aug, 2020
Reviewer #2 agreed
On 17 Aug, 2020
Reviewer #1 agreed
On 31 Jul, 2020
Editor assigned
On 28 Jul, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
Submission checks complete
On 28 Jul, 2020
Editor invited
On 28 Jul, 2020
First submitted
On 22 Jul, 2020
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Subject Areas
Geriatrics & Gerontology
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This preprint is under consideration at BMC Geriatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: Evidence from a nationally representative survey
Umesh Ghimire
New ERA
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4246-8379
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 13 Jan, 2021
Published
On 12 Jan, 2021
No community comments so far
Submission checks complete
On 03 Jan, 2021
Editorial decision: Accept
On 29 Dec, 2020
No comments provided
Reviewer #1 agreed
On 10 Dec, 2020
Editor assigned
On 09 Dec, 2020
Reviewers invited
Invitations sent on 09 Dec, 2020
Submission checks complete
On 09 Dec, 2020
Editor invited
On 09 Dec, 2020
No comments provided
Review #2 received
Received 23 Nov, 2020
Editorial decision: Minor revision
On 23 Nov, 2020
Review #1 received
Received 28 Oct, 2020
Reviewer #2 agreed
On 22 Oct, 2020
Reviewer #1 agreed
On 12 Oct, 2020
Editor assigned
On 07 Oct, 2020
Reviewers invited
Invitations sent on 07 Oct, 2020
Submission checks complete
On 06 Oct, 2020
Editor invited
On 06 Oct, 2020
No comments provided
Review #2 received
Received 08 Sep, 2020
Editorial decision: Major revision
On 08 Sep, 2020
Review #1 received
Received 26 Aug, 2020
Reviewer #2 agreed
On 17 Aug, 2020
Reviewer #1 agreed
On 31 Jul, 2020
Editor assigned
On 28 Jul, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
Submission checks complete
On 28 Jul, 2020
Editor invited
On 28 Jul, 2020
First submitted
On 22 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Geriatrics.
Background
In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.
Methods
This study used a sample of 5,319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson’s Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.
Results
Out of total 5,319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.
Conclusions
Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.
Figure 1
Figure 2
Figure 3