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.
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References
Berki, S.E.: A look at catastrophic medical expenses and the poor. Health Aff. 5(4), 138–145 (1986)
Wyszewianski, L.: Financially catastrophic and high-cost cases: definitions, distinctions, and their implications for policy formulation. Inquiry 23(4), 382–394 (1986)
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)
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)
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)
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)
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)
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)
WHO. The World Health Report: Health Systems Financing: the Path to Universal Coverage, p. 2010. World Health Organization, Geneva (2010)
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)
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)
Ichoku, H.E., Fonta, W.M.: Catastrophic healthcare financing and poverty: empirical evidence from Nigeria. J. Soc. Econ. Dev. 11(2), 1–16 (2009)
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)
World Health Organization: World Health Statistics 2016. World Health Organization, Geneva (2016)
National Bureau of Statistics: Nigeria Poverty Profile Report 2010. http://www.nigeriastat.gov.ng/. Accessed 14 Nov 2016
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
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)
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)
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)
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)
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
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)
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)
Gotsadze, G., Zoidze, A., Rukhadze, N.: Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC Health Serv. Res. 9, 69 (2009)
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)
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)
Yardim, M., Cilingiroglu, N., Yardim, N.: Catastrophic health expenditure and impoverishment in Turkey. Health Policy 94, 26–33 (2010)
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)
Ekman, B.: Catastrophic health payments and health insurance: some counterintuitive evidence from one low income country. Health Policy 83, 304–313 (2007)
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)
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)
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)
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)
Buigut, S., Ettarh, R., Amendah, D.D.: Catastrophic health expenditure and its determinants in Kenya slum communities. Int. J. Equity Health 14, 46 (2015)
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)
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
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)
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)
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)
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)
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)
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
Omotosho, O., Ichoku, H.E.: Financial protection and universal health coverage in Nigeria. Int. Aff. Glob. Strategy 51:1–10 (2016). ISSN 2224-8951
Xu, K.: Distribution of Health Payments and Catastrophic Expenditure: A Methodology. World Health Organization, Geneva (2005)
Grossman, M.: On the concept of health capital and the demand for health. J. Polit. Econ. 8(2), 223–255 (1972)
Aday, L.A., Andersen, R.M.: A framework for the study of access to medical care. Health Serv. Res. 9, 208–220 (1974)
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
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.
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The study used secondary data, hence ethical approval is not applicable.
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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
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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