Abstract
Background: The Lancet Commission on Global Health recommends that by 2030 no household should be impoverished while accessing needed surgical operation. Meeting this target in Nigeria is challenging. This study aims to evaluate the payment coping strategies adopted by households in southeast Nigeria in gaining access to needed major surgeries electively. The findings will aid in designing policies towards improving access to needed surgical care.Methods: A hospital-exit cross-sectional survey of households that accessed majorsurgeries electively from the study health institution from July to December 2017. Payment coping strategies were compared across household wealth quintiles and household characteristics. SPSS® version 20 was used for analysis.Results: Household characteristics associated with deployment of extreme payment coping strategies were: household size >6 persons (p=0.001), female-headed households (p=0.001) and lower formal education of household heads (p=0.004), but not household socio-economic status (p=0.16). Whereas 98.7% of uninsured households and 88.5% of insured households drew from household savings, 61.4% of uninsured households and 26.9% of insured households deployed further payment coping strategies beyond drawing from savings (p=0.05).Conclusion: Extreme hardship financing is evidently prevalent among uninsured households accessing major surgical operation electively, irrespective of household socio-economic status.Keywords: Hardship financing, Payment coping strategies, Out-of-pocket payment
Highlights
Gaining access to healthcare services including surgical care remains a dominant feature of discussions on improving health systems worldwide [1]
This study aims to evaluate the payment coping strategies adopted by households in southeast Nigeria in gaining access to needed major surgeries electively
Household characteristics associated with deployment of extreme payment coping strategies were: household size >6 persons (p=0.001), female-headed households (p=0.001) and lower formal education of household heads (p=0.004), but not household socio-economic status (p=0.16)
Summary
Gaining access to healthcare services including surgical care remains a dominant feature of discussions on improving health systems worldwide [1]. Unlike the prepayment mechanisms of financing healthcare services underpinning the different insurance and tax-based health financing models, direct outof-pocket (OOP) payment makes an unexpected demand on an individual’s or a household’s income, which very often cannot be met by routine household budget, a situation known as hardship financing of needed medical care. Such hardship financing can occur irrespective of the socio-economic status of the household [6]. Conclusion: Extreme hardship financing is prevalent among uninsured households accessing major surgical operation electively, irrespective of household socio-economic status
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