Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria.
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.
Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.
Obinna E
OE
Onwujekwe
Benjamin S C
BS
Uzochukwu
Eric N
EN
Obikeze
Ijeoma
I
Okoronkwo
Ogbonnia G
OG
Ochonma
Chima A
CA
Onoka
Grace
G
Madubuko
Chijioke
C
Okoli
D003430:Cross-Sectional Studies; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires