**2. Conceptualising access to reliable healthcare financing: a multi-disciplinary approach**

Access to reliable healthcare financing is conceptualised from multi-disciplinary points of view. Generally, ability to have what it takes to finance healthcare services without any constraining factor(s) whatsoever is fundamental in conceptualising access to healthcare financing. Following from this, access to reliable healthcare financing can mean ability to finance healthcare services without financial hardship. To be able to finance healthcare services without resulting in catastrophic or impoverished spending requires that psychological, economic, geographical, political, social, and cultural factors be put into consideration. Psychological point of view describes access to reliable healthcare financing as when an individual or her financial provider is in her right state of mind to finance healthcare services without resulting in catastrophic or impoverished spending [9]. Although financial resources may be physically available to finance healthcare services, it is believed that such resources are not useful if an individual or her representative is not in right state of thinking. From this perspective, a baby or an insane person does not have access to reliable healthcare financing even if she has all the wealth in this world. Hence, older people or their social support providers are considered to have access to reliable healthcare financing when they are in their right state of mind.

From economic perspective, access to reliable healthcare financing is conceptualised as the need for healthcare financing without financial hardship and the availability of such healthcare financing mechanism to meet the need. While the former explains the demand for reliable healthcare financing, the later describes the supply of reliable healthcare financing [10]. Hence, from economic perspective,

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

an older person is said to gain access to reliable healthcare financing when the need for it meets its supply; that is, when there are available scarce resources (especially financial resources) to meet the insatiable need for healthcare services in old age. Again, while it is possible for adequate resources to be available to meet the need for healthcare financing at a given point in time, distance between health seeker and healthcare provider may be an important constraint. This calls for geographical conceptualization of access to reliable healthcare financing.

From geographer's standpoint of view, access to reliable healthcare financing implies ability of healthcare seeker to be physically present at the geography (or location, place, *et cetera*) where healthcare financing services are required and provided [11]. Although an older person may be psychologically fit to finance healthcare services and may eventually have the financial resources (possibly in bank or at the health insurance provider) to meet her healthcare needs and challenges, she still lacks access to reliable healthcare financing if she is unable to physically collect such financial resources from appropriate quarters to finance her healthcare services probably due to physical frailty, lack of mobility or road block.

Political conceptualisation of access to reliable healthcare financing explains the governmental policies and political structures that influence people's access to financial health resources. In every government, there are various healthcare financing mechanisms or models through which healthcare services can be financed [12]. The proportion of these models in total healthcare spending is determined by the political climate of every country. For instance, the proportion of out-of-pocket (OOP) payment in total healthcare expenditure is higher in developing countries than in developed countries [12]. Also, while healthcare providers receive payment for healthcare services more via health insurance in developed countries, the healthcare providers receive payment for healthcare services more via OOP in developing countries [13]. Hence, an older person who has psychological, economic, and geographical ability/advantage to finance her healthcare services may be denied access if such a person is expected to pay via health insurance of which she is not enrolled. Alternatively, an individual who is enrolled for health insurance may be denied access to reliable healthcare financing if payment from health insurance provider is not available probably as a result of workers' strike due to government inability to meet insurance workers' demands.

From social and cultural point of views, access to reliable healthcare financing can be conceived as involving the relationship between agency and structure. Here, agency represents individual ability to finance healthcare services freely and independently with as limited structural constraints as possible. On the other hand, structure entails the broader social, cultural, and structural patterns, arrangement and organisations within which an individual seeks to finance her healthcare services [10]. From these perspectives, an older person with the ability to finance her healthcare services without resulting in catastrophic or impoverished spending can be constrained if the prevailing healthcare system is challenged such as lack of appropriate medical technology or personnel, among many other challenges that may face healthcare system. Sociologists and Anthropologists have debated on whether primacy should be given to agency or structure in the process of analysing a given social system. For examples, Karl Marx, Émile Durkheim, Bronisław Malinowski, Alfred Radcliffe-Brown, and Max Weber gave priorities to either agency or structure in their social analysis. However, recent sociologists such as Anthony Giddens and Pierre Bourdieu have recognised the vitally importance of both agency and structure in altering a given social system. In his notion of structuration, Giddens (1984) stated that just as an agent can alter prevailing structure, the structure can as well change an agent [14]. Also Bourdieu realised the importance of both agency and structure when he used the concepts of 'habitus', 'field', and 'capital' to denotes actors with structured and structuring structure, social

space where interaction and activities occur, as well as a symbol for the continual remarking of social order respectively [15]. In other words, Pierre Bourdieu used the concepts to explain an interplay in which the external is internalised, just as the internal becomes externalised [10]. Learning from the works of Giddens and Bourdieu, access to reliable healthcare financing is conceptualised as depending not only on individual, household and/or agency, but also on broader social, cultural and/or structural factors of a given social system. Implicitly, access to reliable healthcare financing not only involves internal forces but also external ones [10].

Older people's access to reliable and sustainable healthcare financing requires that sufficient, uninterrupted and continuing funds are available to meet older people's healthcare needs without compromising or negotiating future generations' ability to achieve same purpose. An important step to achieving reliable healthcare financing for the elderly is to ensure that adequate and satisfactory social support is provided, the elderly have free access to funds or financial resources provided by social support system, and that funding increases consistently over the coming years to meet up with the demand of demographic transition. Raising and accessing reliable fund for healthcare financing of the elderly is the responsibility of household, community, state, and non-state actors of every country. Providing access to reliable healthcare financing is crucial for any country that aims at addressing the inevitable healthcare needs and challenges of the elderly.

### **3. Need for access to reliable healthcare financing in old age**

Everyone desires to reach old age. Old age is the age when many life threatening diseases come up and these health challenges are costly to treat or manage. However, current financial capability of average elderly person in Africa as indicated in the income distribution of African countries shows that many Africans will not be able to afford medical treatment in old age [16, 17]. How can the elderly age gracefully? It is through the provision of and access to reliable (and sustainable) healthcare financing. There is therefore dire and urgent need for the elderly to access reliable healthcare financing in order to save the generation of elderly population in Africa. Older people experience a diversity of health states. While some elderly people in Africa are in relatively good physical and mental health, many more others experience considerable disability, and health and care challenges. Existing studies have established that the health of older people determines their productivity and the roles they play in the society, and that the health status and challenges among the elderly varies between and within countries, across sex, residence, ethnicity, and socio-economic status [18]. As a result, while health across the life-course has a significant impact on ageing experience, many older people are unable to adapt to changes in their health and remain independent and productive into very old age.

Common health challenges among older people include arthritis; heart or cardiovascular disease; cancer or malignancy such as lung, liver, and breast cancers; respiratory diseases; Alzheimer's disease; osteoporosis; and diabetes mellitus, among many others [19]. Hence, the need to access reliable healthcare financing for sustainable healthcare, management and/or cure. Aside common health challenges, the needs of older people vary and are often categorised into physical, intellectual, emotional and social needs [20]. Some of these healthcare needs and challenges require reliable healthcare financing and access to them is crucial for healthy ageing. However, access to reliable healthcare financing are not equitably distributed among elderly population in Africa. While third agers (healthy older people after retirement and are assumed to be productive through a range of activities, reaching from paid work to volunteering, informal care-giving, do-it-yourself and care for oneself) tend to have more access to reliable healthcare financing, fourth agers (older people who are unproductive as a result of poor health after their retirement and they represent the traditional stereotype of older people, who can contribute only little, if any, to the development of a state) seem to have less access to reliable healthcare financing.
