Differential access to healthcare as key mediator between retirement income and health wellbeing among retirees in ghana
Andoh, Paul (2018). 'Differential access to healthcare as key mediator between retirement income and health wellbeing among retirees in Ghana' Paper presented at the annual conference of the HDCA, Buenos Aires, Argentina 2018.
Sustainable Development Goal 3 focuses on good health and wellbeing with the target of ensuring healthy lives and promoting wellbeing for all age groups. Formal sector employees in Ghana retire under the Social Security and National Insurance Trust (SSNIT) at the age of 60 and subsequently receive monthly pensions while in retirement. Pension policy reforms in the last four decades have sort to improve the amount of money paid as pensions with the hope that it will lead to improved wellbeing in retirement. Whether this actually happens or not has not received much research attention. In this study, the notions of capability and functioning in Amartya Sen’s Capability Approach has been used to develop a conceptual framework that seeks to understand the relationship between retirement income or pension income (financial capability) and wellbeing of retirees under the SSNIT pension scheme in five domains of wellbeing, including health (functioning). Given that the proportion of retirees under the SSNIT pension scheme that live in Accra, the capital of Ghana, is higher compared with the other region of Ghana, and exposed to the challenges of urban life as elders in their families and society, the study focused on retirees in this area. A mixed methods research approach was used to collect primary data from 330 retirees in Phase 1 of the study (survey), followed by 12 in-depth interviews with purposively selected retirees from the sample in Phase 1 in Phase 2. Inferential statistics was used to establish the contribution of retirement income to wellbeing in health using the survey data and thematic analytical techniques employed in the analysis of qualitative data to show the conditions under which retirees are able to translate their financial capability into useful functioning in health. Assuming a linear relationship between retirement income and wellbeing, a regression model was constructed with financial capability as independent variable and an index of wellbeing in health derived from responses to a set of Likert scale questions in the survey as dependent variable. Preliminary analysis shows a significant relationship between retirement income and health wellbeing such that a unit increase in income leads to a better health wellbeing. The analysis of qualitative data further shows that retirement income (financial capability) directly and indirectly influence the health of retirees but differential access to healthcare results in differential wellbeing outcomes. Retirees with higher retirement income generally have better health wellbeing outcome but this is dependent on a number of factors, key of which is differential access to healthcare. Money is therefore important to the realization of health goals, but this is mediated by multiple factors that can be activated prior to retirement through deliberate actions on the part of individuals and the use of appropriate policy tools. The study contributes to the discourse on retirement income policy reforms in developing countries by drawing attention to non-financial capabilities that can mediate between financial capability and wellbeing in health. Whether pension policy can incorporate the development of retirement capabilities that are non-financial (such as education and training) is a matter that calls for close policy and research attention. At least, the present study leads the way in showing the importance of other capabilities that are non-financial.