title: Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria.
abstract: OBJECTIVE
  There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups.
  
  
  METHODS
  The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care.
  
  
  RESULTS
  The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme.
  
  
  CONCLUSIONS
  The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.
authors: Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria Enugu-Campus, Enugu, Nigeria. Obinna.Onwujekwe@unn.edu.ng
authors: Obinna
authors: O
authors: Onwujekwe
authors: Kara
authors: K
authors: Hanson
authors: Benjamin
authors: B
authors: Uzochukwu
mesh_terms: D000328:Adult; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000191:economics* / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012306:Risk; D012959:Socioeconomic Factors