Abstract
BackgroundOut-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system.MethodsThe study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS.ResultsAll the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this studyConclusionsThere is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.
Highlights
Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria
The reduced number of questionnaires in the six communities when compared with the sample selected was because of some few refusals to be interviewed and refusal to answer some of the questions
Majority of the respondents were males in the rural areas, while the converse was true in the two urban areas
Summary
Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. OOPS for healthcare increased with the introduction of user fees in the health sector and like most African countries, Nigeria introduced user fees as a mode of financing government health services within the framework of the Bamako Initiative revolving drug funds [3]. The introduction of user fees was arguably in response to the severe problems in financing health services in Nigeria, like in most of sub-Saharan Africa. User fees apply to government owned healthcare services in Nigeria with the major aim being to generate more funds for the health sector, so as to improve the quality of services [4]. Patients are charged fees which they mostly pay out-of-pocket
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