title: Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa.
abstract: OBJECTIVE
  The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries.
  
  
  METHODS
  Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use.
  
  
  RESULTS
  In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions.
  
  
  CONCLUSIONS
  This study provides a basis for further investigation of country-specific responses to UHC.
authors.affiliation: Human Sciences Research Council, Pretoria, South Africa; Department of Psychology, University of the Free State, Bloemfontein, South Africa; ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand; kpeltzer@hsrc.ac.za.
authors.forename: Karl
authors.initials: K
authors.lastname: Peltzer
authors.affiliation: Department Public Health and Clinical Medicine Epidemiology, Global Health Umeå University, Umeå, Sweden; Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia.
authors.forename: Jennifer Stewart
authors.initials: JS
authors.lastname: Williams
authors.affiliation: Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia; World Health Organization, SAGE, Genève, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Kowal
authors.affiliation: School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Joel
authors.initials: J
authors.lastname: Negin
authors.affiliation: Department of Anthropology, University of Oregon, Eugene, OR, USA.
authors.forename: James Josh
authors.initials: JJ
authors.lastname: Snodgrass
authors.affiliation: Department of Community Health, University of Ghana, Accra, Ghana.
authors.forename: Alfred
authors.initials: A
authors.lastname: Yawson
authors.affiliation: Department of Community Health, University of Ghana, Accra, Ghana; National Research Council, Institute of Neuroscience, Padova, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Minicuci
authors.affiliation: Independent Consultant, Atlanta, GA, USA.
authors.forename: Liz
authors.initials: L
authors.lastname: Thiele
authors.affiliation: Human Sciences Research Council, Pretoria, South Africa; Office of the Deputy-Vice Chancellor, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa.
authors.forename: Nancy
authors.initials: N
authors.lastname: Phaswana-Mafuya
authors.affiliation: Department of Community Health, University of Ghana, Accra, Ghana.
authors.forename: Richard Berko
authors.initials: RB
authors.lastname: Biritwum
authors.affiliation: World Health Organization, SAGE, Genève, Switzerland; World Health Organization, HIS/HSI, Genève, Switzerland.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Naidoo
authors.affiliation: Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia; World Health Organization, HIS/HSI, Genève, Switzerland.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
mesh_terms: D002681:China; D005260:Female; D005869:Ghana; D006302:Health Services Research; D006801:Humans; D007194:India; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012426:Russia; D013019:South Africa; D019472:Universal Health Insurance
keywords: health care use utilization; low- and middle-income; universal coverage