Multiple access to healthcare plays out clearly in the analysis of qualitative data in this study. The study found four main healthcare access routes: (1) Designated hospitals under the
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National Health Insurance Scheme (NHIS), which all retirees are enrolled in and membership renewed annually; (2) Company health care facilities, which some retirees continue to access for free by virtue of being former employees; (3) Private healthcare arrangements paid for by respondents; and (4) In-kind health services provided by religious groups.
In terms of financing healthcare, apart from services paid under the NHIS and those provided for free by company health facilities and religious groups, respondents also resort to out-of- pocket payments and family financial support, which impacts on high and low income pensioners differently.
Multiple access means having more than one source of financing healthcare needs. This echoes the different mechanisms by which respondents access healthcare and how it directly or indirectly relates to their retirement income. In the first instance, all the respondents had no problem with geographical access to healthcare. There are health facilities near them where they could go for medical attention, although some were privileged to be able to afford more expensive healthcare centres. Differential access to healthcare among the respondents occurs more in financial access to healthcare.
Significantly, the study found some retirees whose only access to healthcare is through the NHIS. Such persons encounter difficulties in accessing healthcare because the NHIS does not cover many of the ailments that older persons report. Moreover, because the NHIS covers only basic or generic drugs, such retirees were disadvantaged when they needed to pay for drugs either by themselves or relying on family financial support (if available). These are mainly lower income pensioners. For instance, Mawusi Amevor, divorced with three children, one of them still in school and living with her. She is hypertensive and has to undergo regular medical check-ups. Although she holds a valid NHIS card, she utilises part of her pension (less than 700 Ghana Cedis per month) or relies on her younger siblings to attend a specialist hospital and to buy drugs prescribed for her by doctors. Touching on the utilization of the NHIS, she notes that:
The hospitals accept the health insurance card. But it seems the money from the health insurance is not enough because the last time I went to check my whole system, I paid 300 Ghana Cedis. Actually, that money was given to me by my younger sister (Mawusi Amevor, low income).
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She was emphatic about the fact that she could not have paid her medical bills without the support of her sister. In the case of William Tetteh who has diabetes and hypertension and whose wife is also a retiree, his healthcare is taken care of entirely by his eldest daughter, although he also has a valid NHIS card. According to him, as far as “health is concerned….my
daughter pays for my check-ups for diabetes, blood pressure, and then my eyes. She pays for everything. I go for check-ups, medicines, she buys” (William Tetteh, low income).
Consequently, he notes that even though he has medical conditions that could reduce his wellbeing, he was not worried because he has financial support from his daughter to enable access to services that manage his situation. In the case of Kofi Amevor who retired in 2013, apart from accessing healthcare at the company clinic along with his wife, he accesses healthcare at specialized private hospitals at his own cost. His view on his physical health was positive because he is able to move about easily without any problem.
I do go to our company clinic. My wife also goes there, except my children because they are grown. As it is now, any time I feel something in my body, I go to the clinic. If I get money and I need further treatment, I go to a private clinic (Kofi Amevor, low income).
Tei Armah (high income) is also enrolled in the NHIS, but he rarely uses that to access healthcare because he has multiple ways to access healthcare. He felt physically healthy and engaged in regular exercises, although he had suspended the practice for a period (he promised to resume the practice).
I don’t think I have serious challenges with health. I am hypertensive, and my former employer still takes care of my medical bills so every month, I visit the hospital and then get some medication. I just walk to the company clinic and they pick my folder and take care of me. Then, the first place I worked, they have also given me an insurance (Nationwide Mutual Health Insurance) so I can use that one too. So I don’t use the national health insurance (Tei Armah, high income).
Kwaku Mensah rarely used his NHIS to access healthcare because he felt very fit and not needing much healthcare. Like all the others, he renews his NHIS annually at a fee of four Ghana Cedis. His view about his wellbeing as far as health was concerned is captured in the statement below:
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I am blessed that I don’t have any particular illness. So I am very particular about my health, especially my heart. I have been checking my blood pressure and occasionally there are some health screening almost every month at our church, so I have been taking part. The reports are very good. So as at now, health wise, I am yet to see whatever will happen. I am very healthy (Kweku Mensah, high income).
References to physical health conditions by both low and high income category respondents suggest that the presence or otherwise of chronic disease conditions in retirement play a role in respondents’ decisions to adopt healthy lifestyles and ability to achieve a desired health wellbeing outcome. This is also tied to respondents’ awareness of and willingness to accept healthy lifestyle changes in order to either prevent the onset of chronic disease or reduce its impact on their lives. The free health service referred to, provided by the church, is equally essential.
Thus having multiple means to access healthcare helps interviewees to function well without much stress on their finances. This however is not the case with those who are enrolled in the NHIS only, and do not have support from family members to finance their healthcare. The question that arises is: what would have happened to the health wellbeing of these retirees without access to company healthcare facilities and support from their families? Retirement income can help retirees take care of their healthcare needs but only to a limited extent, particularly for low income retirees. Multiple means to access healthcare therefore potentially drives the health wellbeing of interviewees, and retirement income directly contributes to it.