National health accounts: Structure, trends and sustainability of health expenditure in Nigeria

Soyibo, Adedoyin; Olaniyan, Olanrewaju; Lawanson, A. A.

doi:10.4314/ajep.v14i1.44195

Cited by 11 publications

(10 citation statements)

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“…Non-profit providers are prominent in Ebonyi State because functioning public sector primary and secondary care facilities are often not available, partly because of resource challenges and because the public sector is unable to recruit and retain health workers in rural settings (Ukwaja et al, 2013 ). In Nigeria, households provide 74% of their total health expenditures and more than 95% of these occur through out-of-pocket payments (Soyibo, Olaniyan, & Lawanson, 2009 ). There is no risk-pooling mechanism in the financing of health care, as the National Health Insurance Scheme in Nigeria currently covers mainly federal government workers and their households, approximately 4% of the population (Onoka, Onwujekwe, Uzochukwu, & Ezumah, 2013 ).…”

Section: Methodsmentioning

confidence: 99%

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

Abimbola

Ukwaja

Onyedum

et al. 2015

Global Public Health

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Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

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Section: Methodsmentioning

confidence: 99%

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

Abimbola

Ukwaja

Onyedum

et al. 2015

Global Public Health

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“…In Nigeria, households provide 70% of their total health expenditures and 90% of these occur through OOP payments [ 21 ]. Although a national policy that exempts TB patients/suspects from paying for consultations, laboratory tests, TB drugs, and hospitalization does exist, it was not effective at the not-for-profit mission hospitals surveyed.…”

Section: Methodsmentioning

confidence: 99%

Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage

et al. 2013

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BackgroundStudies on costs incurred by patients for tuberculosis (TB) care are limited as these costs are reported as averages, and the economic impact of the costs is estimated based on average patient/household incomes. Average expenditures do not represent the poor because they spend less on treatment compared to other economic groups. Thus, the extent to which TB expenditures risk sending households into, or further into, poverty and its determinants, is unknown. We assessed the incidence and determinants of household catastrophic payments for TB care in rural Nigeria.MethodsData used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State, Nigeria. Using household direct costs and income data, we analyzed the incidence of household catastrophic payments using, as thresholds, the traditional >10% of household income and the ≥40% of non-food income, as recommended by the World Health Organization. We used logistic regression analysis to identify the determinants of catastrophic payments.ResultsAverage direct household costs for TB were US$157 or 14% of average annual incomes. The incidence catastrophic payment was 44%; with 69% and 15% of the poorest and richest household income-quartiles experiencing catastrophic activity, respectively. Independent determinants of catastrophic payments were: age >40 years (adjusted odds ratio [aOR] 3.9; 95% confidence interval [CI], 2.0, 7.8), male gender (aOR 3.0; CI 1.8, 5.2), urban residence (aOR 3.8; CI 1.9, 7.7), formal education (aOR 4.7; CI 2.5, 8.9), care at a private facility (aOR 2.9; 1.5, 5.9), poor household (aOR 6.7; CI 3.7, 12), household where the patient is the primary earner (aOR 3.8; CI 2.2, 6.6]), and HIV co-infection (aOR 3.1; CI 1.7, 5.6).ConclusionsCurrent cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB care. Financial and social protection interventions are needed for identified at-risk groups, and community-level interventions may reduce inefficiencies in the care-seeking pathway. These observations should inform post-2015 TB strategies and influence policy-making on health services that are meant to be free of charge.

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“…Paradoxically financial hardship is still common in Nigeria and this has led many households into CHE despite the existence of NHIS. Despite the existence of NHIS the most prevalent form of healthcare financing in Nigeria remains out-of-pocket expenditure (8). Low coverage of the population by NHIS is responsible.…”

Section: Introductionmentioning

confidence: 99%

National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure?

Ilesanmi

Adebiyi

Fatiregun

2014

Int J Health Policy Manag

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Background: The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods: The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results: The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000-680,000 naira (46.7-4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1-118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile (P= 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3-16.8), P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion: Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.

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National health accounts: Structure, trends and sustainability of health expenditure in Nigeria

Cited by 11 publications

References 0 publications

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage

National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure?

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