A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

Abstract

Summary Background In the Nigerian context, preconditions for financial catastrophe are operational as there is high out‐of‐pocket spending (OOPS) on health with low capacity to pay, presence of user fees, and poor prepayment insurance coverage. We reviewed the incidence and determinants of catastrophic health expenditure (CHE) in Nigeria. Methods Databases including PubMed, OVID, EMBASE, CINAHL, and Web of Science were searched for primary research studies on the incidence and determinants of CHE in Nigeria published between 2003 and 2018. Search terms used include household, out‐of‐pocket expenditure, catastrophic health expenditure, and Nigeria. Results Twenty studies that met the inclusion criteria were included in the review. At 10% of total household and nonfood expenditure, the incidence of CHE was 8.2% to 50%, while 3.2% to 100% households incurred CHE at 40% of nonfood expenditure. The incidence of CHE was higher among inpatients and studies with lower threshold definitions. Outpatient CHE was highest for type 2 diabetes and tuberculosis while human immunodeficiency virus (HIV) care incurred the most CHE among inpatients. Determinants of CHE include wealth status, age, gender, place of residence/geographical location, household size/composition, educational status, health insurance status, illness, and health provider types. Conclusion There is a high incidence of CHE across various common health conditions in Nigeria. CHE was more among the poor, elderly, rural dwellers, private facility utilization, female gender, and noninsured among others. We recommend expansion of the National Health Insurance Scheme via informal social and financing networks platforms. Increased budgetary allocation to health and intersectoral collaboration will also play a significant role in CHE reduction.

Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria

“…Our study illustrates that men take responsibility for the reproductive health of their spouses which corroborates the literature that has also been shown in mother to child transmission of HIV research [ 76 ]. Correlation between a higher incidence of CHE with female gender, private facility utilization in this study is supported by findings from Okedo-Alex et al (2019) [ 77 ]. Although Cleopatra and Eunice (2018) found a reduced incidence of CHE with utilization of private facilities [ 58 ], a key driver why clients are more likely to experience CHE in private facilities is the relative higher cost at which healthcare services are provided in the quest to provide quality care [ 78 ].…”

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

“…Although several studies analysed nationally-representative surveys, their findings differ from ours because they do not address a specific illness, target chronic conditions, and may have limited applicability to our study setting due to subnational differences in healthcare seeking behaviour. [18,41,42] At CHE 10 , the cost of treatment costs had significant burden on households regardless of their income. At higher thresholds, our results are similar to others including those that used household income as a measure of available resources like we did.…”

“…At higher thresholds, our results are similar to others including those that used household income as a measure of available resources like we did. [18,39,40,42,43] Unplanned treatment expenses are likely to affect other household expenditures. OOP payment for healthcare can provide obstacles for treatment access particularly to the poorest, skewing treatment seeking towards only those than can afford to pay.…”

Mapping the Multidimensionality of Medical Care related Catastrophe on Households: A Study of Four Blocks in Birbhum District, West Bengal

“…The study also nds that having elderly and chronically ill members and hospitalizations and OP visits (both in private facility and outside district) in the household signi cantly increases the likelihood of incurring catastrophic medical care expenditure for both the thresholds 1 and 2 [26][27][28][29][30][31][32]. As elderly members are vulnerable to ailments and chronically ill members require multiple OP visits and hospitalization events, they are more likely to incur OOP medical payments.…”