**5.4 Income level**

This is an important economic factor that influences access to reliable healthcare financing. Income level measures the amount or quantity of money or financial resources that an individual receives over a period of time. Individual income level varies and many factors determine a person's income level [16]. When the income level of an individual is high, such an individual has more access to reliable healthcare financing. That is, there is a direct relationship between income level and access to reliable healthcare financing. In Africa, the income level of many older people is low due to many factors resulting in low access to reliable healthcare financing. To help this demographic category of people, engagement in productive activities for those who are still healthy after retirement, compulsory enrolment in health insurance with exemption of premium payment, and strong social support, among many others, may be the alternative means to increase older people's access to reliable healthcare financing. These alternatives become vitally important

because some recent studies confirmed that poverty level or lower income group reduces access to reliable healthcare financing and healthcare utilisation [7, 10].

#### **5.5 Educational attainment**

An individual's level of education is another factor that influences reliable healthcare financing. Operations of modern healthcare system requires that one has certain level of formal education such as ability to communicate officially. Those who lack knowledge of how modern healthcare system operate are sometimes deny access to reliable healthcare financing. For example, many people are excluded from social health insurance because awareness level is low or because they lack the knowledge of how it operates. Those affected are mostly those with low educational attainment. In Africa, most people in the informal sector, which more often correlate with those with lower educational attainment, do not have the privilege of being enrolled in health insurance or have the financial resources that can guarantee financial health protection in old age. According to Zhang et al., less-educated older people have a lower chance of accessing reliable healthcare financing [7]. Hence, elderly possible hope lies in strong social support via their social network in order to experience healthy ageing.

#### **5.6 Social capital**

Social capital refers to network of relationships between or among people in a social system who share common interest, norms, values, and/or identity and who continue to engage in social interaction for the effective functioning of the social system. While social capital depends largely on extent of one's social network, social network in turn depends on the level of effective and functional relationship one has established over one's lifetime [8]. Hence, access to reliable healthcare financing is influenced by the level of relationship one has established in the life course. Older people need social network for effective and efficient healthcare financing considering their health and financial vulnerability, as well as their inability to engage in full productive activity. This is especially true for majority of older people in African who retired mostly from informal sector and who depend mostly on social capital such as children for their healthcare financing. Every potential older person is therefore encouraged to start building strong social networks in the life course as that can represent a safety net in old age [28]. Social support from social network can be informational, instrumental, emotional, or interactional. In a study conducted in United State of American (USA), it was found that informational support has a positive impact on healthcare access disparity among older people [28]. Another study among the elderly in Taiwan demonstrated that social capital in terms of social participation and social network influences access to reliable healthcare financing which invariably determines access to healthcare services [8].

#### **5.7 Geographical factor**

As earlier conceptualised, access to reliable healthcare financing hinges largely on the ability of healthcare seeker to be physically available where healthcare financing services are required and provided. It is important to understand that many older people may have financial wherewithal but may be denied access as a result of their inability to be physically present where they will receive financial health resources or where their healthcare services will be paid for. Access to reliable healthcare financing is therefore influenced by geographical factor of where the health seeker is or where the healthcare services will be financed. In a

#### *Factors Influencing Access to Reliable Healthcare Financing among Elderly Population in Africa DOI: http://dx.doi.org/10.5772/intechopen.99578*

case study of people living with HIV, 'Mdm. A' was denied access to healthcare financing and services as a result of prohibitive transportation costs [29]. Also, in a cross-sectional study in Sweden, it was found that mobility-related factor was associated with health-related quality of life in old age [11]. The issue of being physically present where healthcare financing is required and provided is crucial for many older people on the continent of Africa for them to experience healthy ageing because many of them rely on public transport that are either costly or unreliable. Also, many health seekers in Africa are very distant from where they will receive and finance their healthcare services because reliable healthcare facilities are often located in cities or urban areas and the ones in rural areas are only for the treatment of mild or minor ailment. Moving from rural areas to urban regions, for instance, poses difficulty for many older people in Africa due to transport mobility challenge [10]. Furthermore, intra-urban, intra-continental, and inter-continental disparities in access to reliable healthcare facilities and financing are usual in this present global society [10].
