Skip to main content

Determinants of catastrophic health expenditure in Nigeria

The European Journal of Health Economics volume 19, pages 521–532 (2018)Cite this article

Abstract

Background

Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria.

Methods

Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression.

Results

Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households.

Conclusions

Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Berki, S.E.: A look at catastrophic medical expenses and the poor. Health Aff. 5(4), 138–145 (1986)

    CAS  Article  Google Scholar 

  2. Wyszewianski, L.: Financially catastrophic and high-cost cases: definitions, distinctions, and their implications for policy formulation. Inquiry 23(4), 382–394 (1986)

    CAS  PubMed  Google Scholar 

  3. Wagstaff, A., van Doorslaer, E.: Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ. 12(11), 921–934 (2003)

    Article  PubMed  Google Scholar 

  4. Russell, S.: The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am. J. Trop. Med. Hyg. 71, 147–155 (2004)

    PubMed  Google Scholar 

  5. Xu, K., Klavus, J., Kawabata, K.: Household health system contributions and capacity to pay: definitional, empirical and technical challenges. In: Murray, C., Evans, D., et al. (eds.) Health System Performance Assessment: Debates, Methods and Empiricism, pp. 533–563. World Health Organization, Geneva (2003)

    Google Scholar 

  6. Xu, K., Evans, D.B., Carrin, G., Aguilar-Rivera, A.M., Musgrove, P., Evans, T.: Protecting household from catastrophic health spending. Health Aff. 26(4), 972–983 (2007)

    Article  Google Scholar 

  7. Su, T.T., Kouyate, B., Flessa, S.: Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull. World Health Org. 84(1), 21–27 (2006)

    Article  PubMed  PubMed Central  Google Scholar 

  8. Somkotra, T., Lagrada, L.P.: Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand. Soc. Sci. Med. 67(12), 2027–2035 (2008)

    Article  PubMed  Google Scholar 

  9. WHO. The World Health Report: Health Systems Financing: the Path to Universal Coverage, p. 2010. World Health Organization, Geneva (2010)

    Google Scholar 

  10. Onoka, C.A., Onwujekwe, O.E., Hanson, K., Uzochukwu, B.S.C.: Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries. Trop. Med. Int. Health 16, 1334–1341 (2011)

    Article  PubMed  Google Scholar 

  11. Onwujekwe, O., Hanson, K., Uzochukwu, B., Ichoku, H., Ike, E., Onwughalu, B.: Are malaria treatment expenditures catastrophic to different socio-economic and geographic groups and how do they cope with payment? A study in southeast Nigeria. Trop. Med. Int. Health 15, 18–25 (2010)

    PubMed  Google Scholar 

  12. Ichoku, H.E., Fonta, W.M.: Catastrophic healthcare financing and poverty: empirical evidence from Nigeria. J. Soc. Econ. Dev. 11(2), 1–16 (2009)

    Google Scholar 

  13. Onoka, C.A., Onwujekwe, O.E., Uzochukwu, B.S., Ezumah, N.N.: Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria. Health Res. Policy Syst. 11, 20 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  14. World Health Organization: World Health Statistics 2016. World Health Organization, Geneva (2016)

    Google Scholar 

  15. National Bureau of Statistics: Nigeria Poverty Profile Report 2010. http://www.nigeriastat.gov.ng/. Accessed 14 Nov 2016

  16. WHO: Abuja Declaration: Ten Years On. World Health Organization, Geneva (2010) http://www.who.int/healthsystems/publications/abuja_report_aug_2011.pdf?ua=1. Accessed 14 Nov 2016

  17. Osain, M.W.: The Nigerian health care system: need for integrating adequate medical intelligence and surveillance system. J. Pharm. Bioallied Sci. 3(4), 470–478 (2011)

    Article  Google Scholar 

  18. Wagstaff, A., Cotlear, D., Eozenou, P.H., Buisman, L.R.: Measuring progress towards universal health coverage: with an application to 24 developing countries. Oxf. Rev. Econ. Policy 232(1), 147–189 (2016)

    Article  Google Scholar 

  19. Xu, K., James, C., Carrin, G., Muchiri, S.: An Empirical Model of Access to Health Care, Health Care Expenditure and Impoverishment in Kenya: Learning from Past Reforms and Lessons for the Future. World Health Organization, Geneva (2006)

    Google Scholar 

  20. Knaul, F.M., Arreola-Ornelas, H., Mendez-Carniado, O., Miranda, M.: Preventing Impoverishment, Promoting Equity and Protecting Households from Financial Crisis: Universal Health Insurance Through Institutional Reform in Mexico. Innovations in Health Financing, No. 1. FUNSALUD-Instituto Nacional de Salud Publica, Mexico (2006)

    Google Scholar 

  21. Akinkugbe, O., Chama-Hiliba, C., Tlotlego, N: Health Financing and Catastrophic Payments for Health Care: Evidence from household-Level Survey Data in Botswana and Lesotho. African Economic Research Consortium (AERC). (2011) http://www.repository.up.ac.za/bitstream/handle/2263/21514/Akinkugbe_Health(2012).pdf?sequence=1. Accessed 14 Nov 2016

  22. Cavagnero, E., Carrin, G., Xu, K., Aguilar-Rivera, A.M.: Health Financing in Argentina: An Empirical Study of Health Care Expenditure and Utilization. Fundacion Mexicana para la Salud, A.C. Instituto Nacional de Salud Publica, Mexico (2006)

    Google Scholar 

  23. Rivera, A.M., Xu, K., Carrin, G.: The Bolivian Health System and its imPact on Health Care Use and Financial Risk Protection. World Health Organization, Geneva (2006)

    Google Scholar 

  24. Gotsadze, G., Zoidze, A., Rukhadze, N.: Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC Health Serv. Res. 9, 69 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lamiraud, K., Booysen, F., Scheil-Adlung, X.: The Impact of Social Health on Access to Health Care, Health Expenditure and Impoverishment: A Case Study of South Africa. International Labour Organization, Geneva (2005)

    Google Scholar 

  26. Brinda, E.M., Andres, R.A., Enemark, U.: Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey. BMC Int. Health Hum. Rights 14, 5 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yardim, M., Cilingiroglu, N., Yardim, N.: Catastrophic health expenditure and impoverishment in Turkey. Health Policy 94, 26–33 (2010)

    Article  PubMed  Google Scholar 

  28. Bonu, S., Bhushan, I., Rani, M., Anderson, I.: Incidence and correlates of catastrophic maternal health care expenditure in India. Health Policy Plan. 24, 445–456 (2009)

    Article  PubMed  Google Scholar 

  29. Ekman, B.: Catastrophic health payments and health insurance: some counterintuitive evidence from one low income country. Health Policy 83, 304–313 (2007)

    Article  PubMed  Google Scholar 

  30. Knaul, F.M., Arreola-Ornelas, H., Méndez-Carniado, O., Torres, A.C.: Impoverishing and catastrophic household health spending among families with older adults in Mexico: a health reform priority. In: Angel, J.L., Whitfield, K.E. (eds.) The Health of Aging Hispanics: The Mexican-Origin Population, pp. 237–262. Springer, New York (2007)

  31. Kavosi, Z., Rashidian, A., Pourreza, A., Majdzadeh, R., Pourmalek, F., Hosseinpoor, A.R., et al.: Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan. 27, 613–623 (2012)

    Article  PubMed  Google Scholar 

  32. Somokotra, T., Lagrada, L.P.: Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health Aff. 28(3), 467–478 (2009)

    Article  Google Scholar 

  33. Misra, S., Awasthi, S., Singh, J.V., Agarwal, M., Kumar, V.: Assessing the magnitude, distribution and determinants of catastrophic health expenditure in urban Lucknow, North India. Clin. Epidemiol. Glob. Health 3, 10–16 (2015)

    Article  Google Scholar 

  34. Buigut, S., Ettarh, R., Amendah, D.D.: Catastrophic health expenditure and its determinants in Kenya slum communities. Int. J. Equity Health 14, 46 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  35. Li, Y., Wu, Q., Xu, L., Legge, D., Hao, Y., Gao, L., et al.: Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull. World Health Org. 90, 664–671 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  36. Mondal, S., Kanjilal, B., Peters, D.H., Lucas, H.: Catastrophic out-of-pocket payment for health care and its impact on households: experience from West Bengal, India (2010). http://www.chronicpoverty.org/uploads/publication_files/mondal_et_al_health.pdf. Accessed 14 Nov 2016

  37. Galarraga, O., Sosa-Rubi, S.G., Salinas-Rodriguez, A., Sesma-Vazquez, S.: Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico. Eur J Health Econ. 11, 437–447 (2010)

    Article  PubMed  Google Scholar 

  38. Minh, H.V., Phuong, N.T.K., Saksena, P., James, C.D., Xu, K.: Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002–2010. Soc. Sci. Med. 96, 258–263 (2013)

    Article  PubMed  Google Scholar 

  39. O’Donnell, O., van Doorslaer, E., Rannan-Eliya, R., Somanathan, A., Garg, C.C., Hanvoravongchai, P., et al.: Explaining the incidence of catastrophic expenditures on health care: comparative evidence from Asia. EQUITAP Project Working Paper 5 (2005)

  40. Adisa, O.: Investigating determinants of catastrophic health spending among poorly insured elderly households in urban Nigeria. Int. J. Equity Health 14(79), 1–10 (2015)

    Google Scholar 

  41. Ukwaja, K.N., Alobu, I., Abimbola, S., Hopewell, P.C.: Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants and policy implications for universal health coverage. Infect. Dis. Poverty 2(21), 1–9 (2013)

    Google Scholar 

  42. Ilesanmi, O.S., Adebiyi, A.O., Fatiregun, A.A.: National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure? Int. J. Health Policy Manag. 2(4), 175–180 (2014). doi:10.15171/ijhpm.2014.39

    Article  PubMed  PubMed Central  Google Scholar 

  43. Omotosho, O., Ichoku, H.E.: Financial protection and universal health coverage in Nigeria. Int. Aff. Glob. Strategy 51:1–10 (2016). ISSN 2224-8951

  44. Xu, K.: Distribution of Health Payments and Catastrophic Expenditure: A Methodology. World Health Organization, Geneva (2005)

    Google Scholar 

  45. Grossman, M.: On the concept of health capital and the demand for health. J. Polit. Econ. 8(2), 223–255 (1972)

    Article  Google Scholar 

  46. Aday, L.A., Andersen, R.M.: A framework for the study of access to medical care. Health Serv. Res. 9, 208–220 (1974)

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Mukherjee, M., Kanjilal, B., Mazumdar, P.G.: Health shock vulnerabilities and its correlates: exploring the linkages for in-patient care seekers in West Bengal, India (2010). http://www.chronicpoverty.org/uploads/publication_files/mukherjee_vulnerability.pdf. Accessed 11 May 2017

Download references

Acknowledgments

We acknowledge Mr. Sunday J. Ichedi and Mr. Leo Sanni of the National Bureau of Statistics for providing access to the micro data of the Harmonized Nigeria Living Standard Survey (HNLSS) 2009/10.

Author information

Affiliations

  1. Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Mushin, Lagos, Nigeria

    Bolaji Samson Aregbeshola

  2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Samina Mohsin Khan

Authors
  1. Bolaji Samson Aregbeshola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samina Mohsin Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bolaji Samson Aregbeshola.

Ethics declarations

Informed consent

The authors declare that they have no conflicts of interest.

Ethical approval

The study used secondary data, hence ethical approval is not applicable.

Funding

There was no funding support for this study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aregbeshola, B.S., Khan, S.M. Determinants of catastrophic health expenditure in Nigeria. Eur J Health Econ 19, 521–532 (2018). https://doi.org/10.1007/s10198-017-0899-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-017-0899-1

Keywords

  • Out-of-pocket payments
  • Catastrophic health expenditure
  • Harmonized Nigeria Living Standard Survey
  • Financial risk protection
  • Health equity

JEL Classification

  • I19