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Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study



This study estimated out-of-pocket health-care spending and its determinants among households in Nigeria.


Using secondary data from the 2009/2010 Harmonized Nigeria Living Standard Survey, we estimated the determinants of out-of-pocket health-care spending in Nigeria. The Heckman two-step selection model was used to analyse household and individual decisions to seek care and how much to spend on health care. Data were analysed using STATA version 12 software.


Results from the Heckman selection model indicated that having household heads with primary education, having household heads with secondary education, having more than five members in the household, households residing in the South East region, having head of the household being employed, households visiting public health facilities, and having household members with chronic illnesses were factors that increased the likelihood of incurring out-of-pocket health-care spending.


Our findings suggest that individual and household characteristics increase the risk of incurring out-of-pocket health-care spending. Policy makers and political actors need to stop the high reliance on out-of-pocket health-care spending as a means of financing the Nigerian health system by increasing public health expenditure. The design and implementation of a tax-based non-contributory health financing system for the poor, vulnerable, and informal sector workers would be more helpful for implication at a national level.

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Correspondence to Bolaji Samson Aregbeshola.

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The authors declare that they have no conflict of interest.

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Secondary data were used for this study. In obtaining the micro data, a request was made on the National Bureau of Statistics website and approval was granted to download the data; hence, there were no ethical issues of concern. These data are public and freely available to anyone from National Bureau of Statistics on request. The website for NBS is

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Aregbeshola, B.S., Khan, S.M. Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study. J Public Health (Berl.) 29, 931–942 (2021).

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  • Out-of-pocket expenditures
  • Health policy
  • Heckman selection model
  • Households
  • Nigeria