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Population ageing is a demographic transition and burdens every country’s health sector. A lack of social security combined with low government health-sector spending has made health-care utilisation difficult among elderly in many developing countries like India. This makes population ageing a global phenomenon for policymakers, researchers and stakeholders to discuss and debate in 21st century. The purpose of this paper is to examine the behavioural determinants of health-care utilisation among elderly population in Punjab.

This study examines health-care utilisation among the elderly population in Punjab. A structured questionnaire was used to collect the data in the state of Punjab, with a multi-stage stratified random sample of 385 respondents. Logit regression was used to analyse the association between several behavioural factors like age, gender, place of residence, source of livelihood, education and frequency of visits with health-care utilisation among elderly aged 60 and above.

This study revealed that gender, age, place of residence, source of livelihood, education and frequency of visits were significant determinants of health-care utilisation among elderly population.

This study directs the need to improve health-care utilisation in a country, reducing inequalities that exist among the elderly population with respect to socio-economic and demographic differences.

This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth.

The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership.

Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries.

To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330

Continuity of care and access to primary care have been identified as important contributors to improved health outcomes and reduced reincarceration among people who are justice-involved. While the disproportionate burden of health concerns among incarcerated populations is well documented, less is known about their health service utilization, limiting the potential for effective improvements to current policy and practice. This study aims to examine health status and health care utilization among men recently released from a superjail in a large metropolitan area to better understand patterns of use, risk factors and facilitators.

Participants included adult men (n = 106) matched to a general population group (n = 530) in Ontario, Canada, linked to medical records (88.5% linkage) to examine baseline health status and health utilization three-months post-release. The authors compared differences between the groups in baseline health conditions and estimated the risk of emergency department, primary care, inpatient hospitalization and specialist ambulatory care visits.

Superjail participants had a significantly higher prevalence of respiratory conditions, mental illness, substance use and injuries. Substance use was a significant risk factor for all types of visits and emergency department visits were over three times higher among superjail participants.

This empirical case is illustrative of an emerging phenomenon in some regions of the world where emergency departments serve as de facto “walk-in clinics” for those with criminal justice involvement. Strategic approaches to health services are required to meet the complex social and health needs and disparities in access to care experienced by men released from custody.

The reasons for and experiences during migration, as well as additional stressors in the new host country, may give rise to mental health problems and additional need for public services. The purpose of the study was to investigate factors related to service utilization among newly arrived refugee youth.

Cross-sectional data were gathered in Sweden where 37 youth aged between 19 and 23 reported on factors related to service utilization, encompassing health-care and support services in school. These factors included predisposition (demographic), need (migration status and mental wellbeing) and enablement (living situation). Service utilization was estimated using multiple logistic regression analysis.

About a fourth of the sample used psychosocial services. Use of general support was more common. Neither predisposing, need nor enabling factors were associated with the use of psychosocial or general health-related services.

Self-reported factors related to use of health-related services have previously not been investigated for refugee youth, which is important in assuring access to appropriate services for this exposed youth population.

This study aims to identify the reasons for unmet health-care needs and related barriers among the Roma population with chronic diseases in Jordan.

A descriptive survey with a cross-sectional design was conducted, involving a sample of 347 Jordanian Roma participants. Data collection was performed using a structured questionnaire based on the Canadian Community Health Survey.

The analysis revealed that within the three categories of reasons for unmet health-care needs (accessibility, availability and acceptability), “Transportation issues” under the accessibility category constitute the most reported reasons: (mean = 90.4%, SD = 22.6%), followed by “Cost” (mean = 89.0%, SD = 26.2%) and “Care not available in the area” (mean = 85.8%, SD = 23.6%). Predictors of unmet health-care needs were being married, having health insurance and self-perception of mental health (OR = 0.215, p = 0.044), (OR = 0.391, p = 0.008) and (OR = 0.302, p = 0.002) respectively.

Unmet health-care needs are highly prevalent among Jordanian Roma, rendering them a vulnerable group susceptible to other diseases. To address this pressing issue, concerted and comprehensive efforts should be made to improve the utilization and accessibility of health-care services within this community. Furthermore, efforts should be made to elevate their social standing and status. facilitate their integration into the broader community.

Research has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.

Using a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.

The results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).

Rwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059

This chapter reviews the evidence on the role of physicians in shaping inequalities in access to and utilisation of healthcare. The authors examine three types of physician decisions that can influence inequalities in access and utilisation: location decisions, decisions to work in the public and/or private sector, and decisions or behaviours in the doctor–patient encounter. For each, the authors summarise the issues and empirical evidence on possible policies to help reduce inequalities in access. Future research to reduce inequalities should focus on changes to health systems that influence physician decisions, such as health insurance expansions, the public–private mix and financial incentives, as well as physician training and policies for a more diverse physician workforce.

Following the introduction of user fee for interpreting in Danish health care, a considerable decrease in interpreter services has been shown. This study aims to explore the experiences of language minority patients with health-care encounters when an interpreter was needed but not present.

Semistructured, in-depth interviews were conducted with 13 language minority patients with limited Danish proficiency. All interviews were conducted with interpreters in the participants’ native language. Data were analyzed using an inductive thematic approach.

Most participants experienced communication difficulties and difficulties participating actively in their own health care. The experience of unresolved language barriers led to a high degree of uncertainty and left the participants with unanswered health concerns. Participants expressed a reluctance to seek health care, which consequently limited the utilization of health care services.

Although the findings only represent a small sample of patients, the results still reveal major challenges that minority-language patients encounter when seeking health care. Future studies should explore, if the intention of the law is met through the user fees.

Despite having the same entitlements as native Danish-speaking patients, minority-language patients experienced difficulties accessing and using health care services due to the user fee and unresolved language barriers. The study elucidates patient perspectives and points to important ways of improving the quality of health care.

To the best of the authors’ knowledge, no investigation into the communicative consequences of the introduction of the user fee for interpreting services exists. Thus, this study seeks to address that gap.

Many refugees and asylum seekers in Germany experience a high disease burden and low health literacy. The current study aims to focus on assessing these issues among African refugees and asylum seekers in Bavaria, Germany. The authors evaluated their self-perceived health status and health literacy, and identified barriers and gaps in health care utilization, intending to improve health care services for this group.

The authors conducted a cross-sectional, questionnaire-based study involving 69 refugees and asylum seekers from Ethiopia, Eritrea and Nigeria. The authors performed descriptive and exploratory statistical analyses.

The authors found a substantial disease burden in the early stages of resettlement in Germany, particularly mental health symptoms (53.6%) and musculoskeletal problems (47.8%). Challenges in health literacy were observed, such as difficulties in understanding health information and managing emergency situations. Access to interpreters was limited, and understanding treatment certificates was more challenging than using electronic health cards, with 18.2% of participants reporting denial of medical treatment.

These findings highlight the need for early and tailored health support for refugees, with a particular focus on mental health. Efforts should be made to reduce language barriers and improve navigational skills within the health-care system, particularly in emergency situations. Addressing the restricted access to health care and bureaucratic obstacles is crucial for improved health outcomes among refugees.

To the best of the authors’ knowledge, this research is the first to specifically explore the self-reported health status and health literacy of African refugees and asylum seekers in Bavaria, Germany, providing valuable insights into the unique healthcare challenges of this often underrepresented and overlooked population.

In most Sub-Saharan African countries, a widely adopted policy to increase access to healthcare is the complete or partial removal of health user fees. This paper examines the effect of removing health user fees on the cognitive development of children in Ghana.

The study uses the Ghana Socioeconomic Panel Survey (GSPS) and a difference-in-differences method to analyze the impacts of free healthcare.

The findings show that improved access to healthcare enhances the cognitive ability of children. More importantly, children who received free healthcare in early life experienced significant improvement in their cognitive ability. The benefits are also huge for girls and children from low-income families. The findings further show that maternal health, the timely receipt of vaccinations and regular infant health visits are important operative channels through which improved access to healthcare affects children’s cognitive ability.

There are several studies on the effects of eliminating health user fees on various outcomes, but only a few focus on children’s outcomes. This study contributes to the literature by focusing on a vital child outcome, cognitive ability and exploring the timing and pathways through which abolishing health user fees affect cognitive development in children. Because cognitive ability is crucial for educational and labor market outcomes, the findings are useful for policymakers in determining the population to target and the timing of interventions that yield huge impacts when designing health intervention programs in developing countries.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-11-2022-0739.