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Open Access Research article

Viewing health expenditures, payment and coping mechanisms with an equity lens in Nigeria

Oforbuike Ewelukwa1*, Chima Onoka12 and Obinna Onwujekwe13

Author Affiliations

1 Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria

2 Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria

3 Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria

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BMC Health Services Research 2013, 13:87  doi:10.1186/1472-6963-13-87

Published: 9 March 2013

Abstract

Background

This paper examines socio-economic and geographic differences in payment and payment coping mechanisms for health services in southeast Nigeria. It shows the extent to which the poor and rural dwellers disproportionally bear the burden of health care costs and offers policy recommendations for improvements.

Methods

Questionnaires were used to collect data from 3071 randomly selected households in six communities in southeast Nigeria using a four week recall. The sample was divided into quintiles (Q1-Q5) using a socio-economic status (SES) index as well as into geographic groups (rural, peri-urban and urban). Tabulations and logistic regression were used to determine the relationships between payment and payment coping mechanisms and key independent variables. Q1/Q5 and rural/urban ratios were the measures of equity.

Results

Most of the respondents used out-of-pocket spending (OOPS) and own money to pay for healthcare. There was statistically significant geographic differences in the use of own money to pay for health services indicating more use among rural dwellers. Logistic regression showed statistically significant geographic differences in the use of both OOPS and own money when controlling for the effects of potential cofounders.

Conclusions

This study shows statistically significant geographic differences in the use of OOPS and own money to pay for health services. Though the SES differences were not statistically significant, they showed high equity ratios indicating more use among poor and rural dwellers. The high expenditure incurred on drugs alone highlights the need for expediting pro-poor interventions like exemptions and waivers aimed at improving access to health care for the vulnerable poor and rural dwellers.

Keywords:
Equity; Socio-economic status; Payment mechanism; Health expenditure