Journal of Health and Medical Sciences
Published: 10 May 2021
The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison
Paul Oladapo Ajayi, Demilade Olusola Ibirongbe, Tope Michael Ipinnimo, Oluremi Olayinka Solomon, Austin Idowu Ibikunle, Adaora Elizabeth Obiagwu
Ekiti State University Teaching Hospital (Nigeria), University of Medical Sciences (Nigeria), Federal Teaching Hospital (Nigeria), Edo University (Nigeria)
Download Full-Text Pdf
Keywords: Household Catastrophic Health Expenditure, Out of Pocket Payments, Nigeria
Background: Catastrophic health expenditure occurs when the burden of Out-of-pocket health expenditure has reached a certain level that a household must forego the expenditure on other basic needs of life to meet the health expenses of its member(s) of the household. Worldwide, over 44 million households suffer annually from financial catastrophe. This study intends to determine the prevalence of household catastrophic health expenditure amongst rural and urban communities in Ekiti, Nigeria. Methodology: This is a comparative cross-sectional study of households within selected rural and urban communities in Ekiti State, Nigeria. A pre-tested interviewer-administered semi-structured questionnaire was used to collect data over a period of 4 months from a sample of 1,000 household heads, using a multistage sampling technique. Data obtained were then entered using the SPSS version 20 and analysed with STATA 12. Two different methodologies were used to calculate household catastrophic health expenditure, with sensitivity analysis done. Univariate analysis were used to describe the population in relation to relevant variables. Result: The prevalence of household catastrophic health expenditure is high using the two methodological calculations. It was significantly higher in the rural areas, 18.5% than the urban areas, 12.8% (p=0.015) for first method; it was also higher in the rural areas, 8.3% compared to the urban areas, 2.5% (p<0.001) for the second method. Conclusion: Prevalence of household catastrophic health expenditure is high in Nigeria, but worse in the rural areas. It’s therefore vital to establish financial and social intervention mechanisms that can protect households from incurring catastrophic health expenditure.
Adisa O. (2015). Investigating determinants of catastrophic health spending among poorly insured elderly household in urban Nigeria. International Journal for Equity in health, 14: 78. doi:10.1186/s12939-015-0188-5. (accessed 14th July, 2016).
Aditi AB. (2014). Catastrophic health expenditures: Why leave out the non-users. International Journal for Research in Management and Pharmacy, 3(3):73-78. (ISSN: 2320-0901).http://www.raijmr.com/wp-content/uproads/2014/15/10_73-78-Aditi-A-Bansal.pdf.
Akinkugbe O, Chama-Chiliba CM, Tlotlego N. (2012). Health financing and catastrophic payments for health care: Evidence from Household-survey data in Botswana and Lesotho. African Development Review, 24(4):358-370.
Amakom U, Ezenekwe UR. (2012). Implication of households catastrophic out of pocket (OOP) healthcare spending in Nigeria. Journal of Research in Economics and International finance, 1(5): 136-140. (Available online http:www.interjournal.org/JREIF). (Accessed on 7thNovember 2016).
Arce HE. (2019). How to face the rising cost of healthcare? Medicina (B Aires), 79(Spec 6/1):529-533 English.PMID:31864221.
Bennett S, Ozawa S, Rao KD. (2010). Which path to Universal Health Coverage? Perspectives on the World health report 2010. PLoS Med, 7(11):e1001001. Doi:10.137/journal.pmed.1001001. (accessed on 31st December 2016).
Boerma T, Eozenou P, Evans D, Evans T, Kieny MP, Wagstaff A.(2014). Monitoring progress towards universal health coverage at country and global levels. PLoS Medicine.11(9):e1001731. doi:10.137/journal.pmed.1001731.
Brinda EM, Altermann. J., Kowal P, Enemark U. (2014). Prevalence and determinant of catastrophic health expenditures among older people in six low and middle income countries.In: European health economics association PHD student- Supervisor and early career researcher conference. Poster presentation (MAN131194) Manchester, United Kingdom. 1st September-3rd September 2014. http://pure.au.dk/portal/en/activities/european-health-economics-assocition-phd-student-supervisor-and-early-career-reseacher-(84996e12-360e-46e5-bd5a-7f988142cc30).html.
Brinda EM, Andres AR, Enemark U. (2014). Correlates of out-of -pocket and catastrophic health expenditures in Tanzania: results from a national household survey. BMC International health and Human Right, 14:5.
Buiqut S, Ettarh R, Amenda DD. (2015). Catastrophic health expenditure and its determinant in Kenya Slum Communities. International Journal for Equity in Health, 14:46.
Douglas GB and Thomas AW. (2014). Cronbach’s alpha reliability: Interval estimation, hypothesis tesing and sample size planning. Journal of organisational behavior, 36(1):1-13.
Gordis L. (2004). The natural history of disease: Ways of expressing prognosis. ln: Schmitt W (ed) Epidemiology. 3rd ed. Philadelphia: Elsevier Saunders; p95 -114.
Hsiao WC. (2000). “What should marco economist know about healthcare policy, A Primer” IMF working papers 00/136 international monetary fund Washington, D.C.
Ilesanmi OS, Adebiyi AO, Fatiregun AA. (2017). Contribution of household health care expenditure to poverty in Oyo State, South West Nigeria: A rural and urban comparison. J Health Man & Info, 4(3):64-70.
Ilesanmi OS, Adebiyi AO, Fatiregun AA. (2014). National health insurance scheme: how protected are household in Oyo State, Nigeria from catastrophic health expenditure? International Journal of Health policy and management, 2(4): 175-180.
Jekel JF, Katz DL, Elmore JG. (2001). Sample size, randomization, and probability theory. Maddox S, Schmitt W (eds) Epidemiology, Biostatistics and Preventive medicine. 2nd Ed Philadelphia: Saunders Elsevier; 194-199.
Joglekar R. (2008). Can insurance reduce catastrophic out-of pocket health expenditure? PHD thesis; A working paper Indira Gandhi Institute of development research, Mumbai,India.
Ke X, David BE, Guy C and Ana MA. (2005) Designing health financing systems to Reduce Catastrophic health expenditure. Technical brief for policy-makers. World Health Organization. Report number: 02, 2005. http://www.who.int/iris/handle/10665/70005 (assessed on 12 May, 2016).
Knaul FM, Wong R, Arreola-ornelas H, Mendez O. (2011). Network on health financing and Social protection in Latin America and the Caribbean (LANET). Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean countries. Salud publica Mexico, 53(2): s85-95.
Olatunya OS et al. (2015). Financial burden of sickle cell disease on household in Ekiti, southwest Nigeria. Clinicoecon Outcomes Res., 7:545-553.
Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu B. (2010). Measuring Catastrophic Healthcare expenditure in Nigeria Implication for financial risk Protection. CREHS Research brief. March 2010. http:www.crehs.lshton.ac.uk (accessed June 3, 2016).
Onwujekwe O, Chukwogo O, Ezeoke U, Uzochukwu BSC. (2010). Asking people directly about preferred health-seeking behaviour yields invalid response: an experiment in the South-east, Nigeria. Journal of public health, 33(1):93-100.
Onwujekwe O, Hanson K, Uzochukwu B. (2012). Examining inequalities in incidence of Catastrophic Health Expenditure on Different Healthcare services and health facilities in Nigeria. PLoS ONE, 7 (7): e40811. doi: 10.1371/journal.pone.0040811.(accessed on 5th December 2016).
Onwujekwe OE, Uzochukwu BS, Obikeze EN, Okoronkwo I, Ochonma OG, Onoka CA et al. (2010). Investigating determinants of out-of-pocket spending and strategies for coping with payment for health in southeast, Nigeria. BMC Health Service Research, 10: 67. (Electronic supplementary material 12913 2009 1204 MOESMI ESM.DOC. Additional file:household questionnaire).
Onwujekwe O, Uzochukwu B, Kirigia J. (2011). Basis for effective community-based Health Insurance schemes: investigating inequities in catastrophic out-of-pocket health expenditures, affordability and altruism. African journal of health economics,1:11.
Onwujekwe O, Uzochukwu B, Onoka C. (2011). Assessing the use and cost of healthcare services and catastrophic expenditures in Enugu and Anambra states, Nigeria. CREHS Policy brief 2011. website: http:www.creshs.lshtm.ac.uk (accessed 31st December 2016).
Puteh SEW, Almualm Y. (2017). Catastrophic Health Expenditure among Developing Countries. Health Syst Policy res.,4:1.
Rashad AS, Sharaf MF. (2015). Catastrophic Economic Consequences of healthcare payments: Effect on poverty estimates in Egypt, Jordan and Palestine. Economies, 3(4):216-234.
Rezapour A, Ghaderi H, Azar FE, Larijani B, Gohari MR. (2013). Effect of health out-of-pocket payment on household in Iran; catastrophic and impoverishment population based study in Tehran (2012). Life science journal, 10(3):1457-1469.
Saito E, Gilmour S, Rahman MM, Gankin GS, Shrestha PK, Shibuya K.(2014). Catastrophic household expenditure on health in Nepal a Cross-sectional survey. Bulletin, WHO, 9:760-767.
Su TT, Kouyate B, Flessa S. (2006). Catastrophic Household expenditure for healthcare in a low income society: a study from Nouna District, Burkina Faso. Bulletin of the World Health Organization, 84(1):21-27.
The World Bank. (2016). Nigeria: Country at a Glance. Weblog. http://www.worldbank.org/en/country/nigeria (accessed 31st December 2016).
The World Bank. (2016). GDP per capita (current USD).World bank national account data and OECD national accounts data files. Weblog. http://data .worldbank.org/indicator/NY.GDP.PCAP.CD (accessed 31st December 2016).
Ukwaja KN, Alobu I, Abimbola S, Hopewell PC. (2013). Household Catastrophic payments for tuberculosis care in Nigeria: incidence, determinants and policy implications for universal health coverage. Infectious Disease of Poverty, 2(1): 21.
United Nation Development Programme. (2016) National Human Development Report 2016 about Nigeria. http://www.ng.undp.org/content/nigeria/en/home/library/poverty /national-human-development-report-2016.
Vyas S, Kumaranayake L. (2006). Constructing Socio-Economic Status indices: how to use principal component analysis. Health policy and planning, 21 (6):459-68.
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus RJ, Murray JLC. (2003). Household Catastrophic health expenditure: a multi-country analysis. THE LANCET , 362(9378):111-117.
World Bank. Basics of Heath Economics, Self paced module 8 page 6https://olc.worldbank.org/content/basis-health-economics-self-paced? module 8 page 6. (Accessed on 15 July, 2016).
World Bank Group. (1996). Living Standards Survey; State statistics of the Republic of Armenia. Household Questionnaire–English-World Bank Group (electronic copy/PDF).Weblog Siteresources.worldbank.org/INTLSMS.arm01pdf (Assessed 5 February, 2018).
World Bank. (2016). Nigeria Overview. Weblog http://www.worldbank.org/en/country/nigeria/overvwiew.(Accessed 5th August, 2016).
World Health Organization. (2016). External health expenditure per capita (current USD). Global health expenditure database. Weblog. http://data.worldbank.org/indicator/SH.XPD.PCAP (accessed 31st December 2016).
World Health Organization. (2016) Media centre: Medical costs push millions of people into poverty across the globe. Weblog. http://www.who.int/mediacentre/news/releases/2005/pr65/en/. (accessed on 31st December 2016).
World Health Organization. (2012). Spending on health: A global overview, Fact sheet N0 319April 2012. Weblog. http://www.who.int/mediacentre/factsheets/fs319/en (accessed on 6, December 2016).
World health organization. (2011). The Abuja declaration: Ten years on Geneva: WHO 2011. Weblog. http://www.who.int/healthsystems/publications/abuja_declaration/en/ (accessed on 5th June 2016).
World Health Organization. (2016). Universal health coverage. Weblog. http://www.who.int/mediacentre/factsheet/fs395/en/. (Downloaded on October 6, 2016).
World Health Organization. (2002). World health survey 2002. A Household Questionnaire. whslonghouseholdlow.pdf. Weblog. (Downloaded 2 December, 2017)
Yardim MS, Cilingiroglu N, Yardim N. (2010). Catastrophic health expenditure and impoverishment in Turkey. Health policy, 94(1):26-33.