The future of long-term care financing in Ghana: preferences among dual-role unorganised caregivers of older adults

Long-term care (LTC) demand in Ghana is increasing due to rapid population ageing, raising concerns about how care can be sustainably financed. In the absence of a formal LTC system, care is largely provided and financed by unorganized family caregivers who often assume both caregiving and financial responsibilities. The study examined preferences for LTC financing models among such caregivers and assessed how these preferences are shaped by caregiving beliefs, caregiver-recipient relationships, and specific caregiving tasks. A cross-sectional survey of 1116 dual-role caregivers across three regions of Ghana was conducted. Multinomial logistic regression models were estimated, and results were presented as average marginal effects comparing preferences for insurance-based and tax-financed models relative to family or out-of-pocket financing. The results show that greater intensity of personal care provision was associated with a higher probability of preferring insurance-based financing, increasing the probability by about 3.6 percentage points (dy/dx = 0.036, p = 0.002). Similarly, greater provision of emotional support increased the probability of preferring tax-financed models by approximately 7.8 percentage points (dy/dx = 0.078, p < 0.001). These associations varied by caregiver-recipient relationship and caregiving beliefs. Sustainable LTC financing in Ghana should therefore reflect caregiving intensity, beliefs, and income differences among caregivers.