Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria

Article


Onwujekwe, Obinna E., Uzochukwu, Benjamin S. C., Obikeze, Eric N., Okoronkwo, Ijeoma, Ochonma, Ogbonnia G., Onoka, Chima A., Madubuko, Grace and Okoli, Chijioke. 2010. "Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria." BMC Health Services Research. 10, pp. 1-10. https://doi.org/10.1186/1472-6963-10-67
Article Title

Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria

ERA Journal ID13444
Article CategoryArticle
AuthorsOnwujekwe, Obinna E., Uzochukwu, Benjamin S. C., Obikeze, Eric N., Okoronkwo, Ijeoma, Ochonma, Ogbonnia G., Onoka, Chima A., Madubuko, Grace and Okoli, Chijioke
Journal TitleBMC Health Services Research
Journal Citation10, pp. 1-10
Article Number67
Number of Pages10
Year2010
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/1472-6963-10-67
Web Address (URL)https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-67
Abstract

Background: Out-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. Methods. The 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. Results: All 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 study. Conclusions: There 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. © 2010 Onwujekwe et al; licensee BioMed Central Ltd.

Keywordsarticle; cross-sectional study; economics; health care cost; human; Nigeria; patient attitude; primary health care; questionnaire; regression analysis; social class; socioeconomics; utilization review
FunderAlliance for Health Policy and Systems Research
Byline AffiliationsUniversity of Nigeria, Nigeria
School of Business
Permalink -

https://research.usq.edu.au/item/w3y49/investigating-determinants-of-out-of-pocket-spending-and-strategies-for-coping-with-payments-for-healthcare-in-southeast-nigeria

  • 35
    total views
  • 12
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

Geographic and socioeconomic inequalities in the survival of children under‑five in Nigeria
Okoli, Chijioke Ifeanyi, Hajizadeh, Mohammad, Rahman, Mohammad Mafizur and Khanam, Rasheda. 2022. "Geographic and socioeconomic inequalities in the survival of children under‑five in Nigeria." Scientific Reports. 12, pp. 1-12. https://doi.org/10.1038/s41598-022-12621-7
Socioeconomic inequalities in teenage pregnancy in Nigeria: evidence from Demographic Health Survey
Okoli, Chijioke Ifeanyi, Hajizadeh, Mohammad, Rahman, Mohammad Mafizur, Velayutham, Eswaran and Khanam, Rasheda. 2022. "Socioeconomic inequalities in teenage pregnancy in Nigeria: evidence from Demographic Health Survey." BMC Public Health. 22, pp. 1-11. https://doi.org/10.1186/s12889-022-14146-0
Inequality in Maternal and Child Health and Healthcare in Nigeria: An Econometric Analysis
Okoli, Chijioke. 2022. Inequality in Maternal and Child Health and Healthcare in Nigeria: An Econometric Analysis. PhD by Publication Doctor of Philosophy (DPHD). University of Southern Queensland. https://doi.org/10.26192/w8v19
Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey
Okoli, Chijioke Ifeanyi, Hajizadeh, Mohammad, Rahman, Mohammad Mafizur and Khanam, Rasheda. 2021. "Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey." Malaria Journal. 20, pp. 1-10. https://doi.org/10.1186/s12936-021-03834-8
Heavy metal content of rice meals sold in a Nigerian market population with a high prevalence of hypertension
Anakwue, Ralph C., Nnakenyi, Ifeyinwa Dorothy, Maduforo, Aloysius N., Young, Ekenechukwu E., Okoli, Chijioke I., Ndiokwelu, Chika I. and Ezenduka, Charles C.. 2021. "Heavy metal content of rice meals sold in a Nigerian market population with a high prevalence of hypertension." Annals of African Medicine. 20 (1), pp. 37-41. https://doi.org/10.4103/aam.aam_12_20
Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017
Okoli, Chijioke, Hajizadeh, Mohammad, Rahman, Mohammad Mafizur and Khanam, Rasheda. 2020. "Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017." BMC Health Services Research. 20, pp. 1-14. https://doi.org/10.1186/s12913-020-05700-w
Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa
Doherty, Jane, Kirigia, Doris, Okoli, Chijioke, Chuma, Jane, Ezumah, N., Ichoku, Hyacinth, Hanson, Kara and McIntyre, Diane. 2018. "Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa." Global Health Action. 11 (1), pp. 1-11. https://doi.org/10.1080/16549716.2018.1461338
Willingness to pay for antiretroviral drugs among HIV and AIDS clients in south-east Nigeria
Mbachu, Chinyere, Okoli, Chijioke, Onwujekwe, Obinna and Enabulele, Fabian. 2018. "Willingness to pay for antiretroviral drugs among HIV and AIDS clients in south-east Nigeria." Health Expectations. 21 (1), pp. 270-278. https://doi.org/10.1111/hex.12612
Socioeconomic status and barriers to the use of free antiretroviral treatment for HIV/AIDS in Enugu State, south-eastern Nigeria
Okoli, Chijioke I. and Cleary, Susan M.. 2011. "Socioeconomic status and barriers to the use of free antiretroviral treatment for HIV/AIDS in Enugu State, south-eastern Nigeria." African Journal of AIDS Research. 10 (2), pp. 149-155. https://doi.org/10.2989/16085906.2011.593377
Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria
Uzochukwu, B. S. C., Onwujekwe, O. E., Onoka, A. C., Okoli, C., Uguru, N. P. and Chukwuogo, O. I.. 2009. "Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria ." Health Policy and Planning. 24 (3), pp. 189-196. https://doi.org/10.1093/heapol/czp006
Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria
Onwujekwe, Obinna, Onoka, Chima, Uzochukwu, Benjamin, Okoli, Chijioke, Obikeze, Eric and Eze, Soluda. 2009. "Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria." Health Policy. 92 (1), pp. 96-102. https://doi.org/10.1016/j.healthpol.2009.02.007
Are there geographic and socio-economic differences in incidence, burden and prevention of malaria? A study in southeast Nigeria
Onwujekwe, Obinna, Uzochukwu, Benjamin, Dike, Nkem, Okoli, Chijioke, Eze, Soludo and Chukwuogo, Ogoamaka. 2009. "Are there geographic and socio-economic differences in incidence, burden and prevention of malaria? A study in southeast Nigeria." International Journal for Equity in Health. 8, pp. 1-7. https://doi.org/10.1186/1475-9276-8-45
Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria
Onwujekwe, Obinna, Uzochukwu, Benjamin, Eze, Soludo, Obikeze, Eric, Okoli, Chijioke and Ochonma, Ogbonnia. 2008. "Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria." Malaria Journal. 7, pp. 1-10. https://doi.org/10.1186/1475-2875-7-5