title: Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries.
abstract: OBJECTIVE
  To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa.
  
  
  METHODS
  We obtained data on 16,631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis.
  
  
  RESULTS
  The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship.
  
  
  CONCLUSIONS
  No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care.
authors.affiliation: Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany .
authors.forename: Christine
authors.initials: C
authors.lastname: Goeppel
authors.affiliation: Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile .
authors.forename: Patricia
authors.initials: P
authors.lastname: Frenz
authors.affiliation: Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany .
authors.forename: Linus
authors.initials: L
authors.lastname: Grabenhenrich
authors.affiliation: Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany .
authors.forename: Thomas
authors.initials: T
authors.lastname: Keil
authors.affiliation: Global Health Science Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Luisenstraße 57, Berlin, 10117, Germany .
authors.forename: Peter
authors.initials: P
authors.lastname: Tinnemann
mesh_terms: D000367:Age Factors; D000368:Aged; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*