Assessment of Out-of-pocket Expenditure on Healthcare Among Households in Keffi
Assessment of Out-of-pocket Expenditure on Healthcare Among Households in Keffi
ABSTRACT
Background: One of the main challenges of accessing health care in Nigeria is payment for service at the point of delivery. Out-of-pocket (OOP) payments being the main method of financing health care, has posed a serious constraint in accessing health care.
This study assessed the socio-economic status of households in relation to out-of-pocket payment and how these have influenced households‟ access to health care in Keffi, Nasarawa state, North Central Nigeria.
It also provided the necessary information on the options available for health care prepayment other than OOPs.
Method: A cross-sectional household based descriptive study design was used to study outof-pocket expenditure on health care by households in the settlement.
A structured closedended interviewer administered questionnaires was administered on eligible 316 household heads or appointed persons selected from listed wards using multistage random sampling technique.
Wealth index was developed to assess the socio-economic status of household heads and the equity of OOPs by the use of Principal Component Analysis (PCA).
Pearson Chi-square test was used to determine the relationship between OOPs and other categorical variables. Logistic regression was used to examine the multivariate relationship of OPPs.
TABLE OF CONTENTS
Title page – – – – – – – – – i
Declaration – – – – – – – – – ii
Certification – – – – – – – – – iii
Dedication – – – – – – – – – iv
Acknowledgement – – – – – – – – v
Summary – – – – – – – – – vi
Table of contents – – – – – – – – vii
List of tables – – – – – – – – – ix
Acronyms – – – – – – – – – xi
Chapter One – Introduction
1.1 Introduction – – – – – – – – 1
1.2 Justification – – – – – – – – 8
1.3 Problem statement – – – – – – – 10
1.4 Research question – – – – – – – 10
1.5 Aims and objectives – – – – – – – 10
1.6 Scope of the study- – – – – – – – 11
Chapter Two – Literature Review
2.1 Health care financing – – – – – – – 13
2.1.1 Revenue collection – – – – – – – 14
2.1.2 Pooled resources – – – – – – – 20
2.1.3 Purchasing – – – – – – – – 21
Chapter Three – Methodology
3.1 Background – – – – – – – – 25
3.2 Study design – – – – – – – – 25
3.3 Study population – – – – – – – – 25
3.4 Inclusion/exclusion criteria – – – – – – 26
3.5 Sampling size determination – – – – – – 26
3.6 Sampling method – – – – – – – 27
3.7 Data collection instrument – – – – – – 28
3.4 Data analysis – – – – – – – – 29
3.5 Ethical consideration – – – – – – – 30
3.6 Limitations – – – – – – – – 31
Chapter Four – Results
4.1 Background characteristics of respondents – – – – 33
4.2 Households sources of finance healthcare services – – – 38
4.3 Proportion of household income spent on healthcare – – – 39
4.4 Factors influencing access to health care services by households – 43
4.5 Perception of best methods for payment for treatment – – – 45
Chapter Five – Discussion, Conclusion and Recommendations
5.1 Discussion – – – – – – – – 47
5.2 Conclusion – – – – – – – – 53
5.3 Recommendation – – – – – – – – 53
References – – – – – – – – – 54
Appendices – – – – – – – – – 59
INTRODUCTION
Out-of-pocket (OOP) expenditure by households was the most important financing agents through which health expenditure sources channel funds to providers for health services in Nigeria and many other low/middle-income countries.
The world Health organization (WHO) defined Out-of-pocket payment for health care as, „the direct outlay of households, including gratuities and payments in kind,
made to health practitioners and supplies of pharmaceuticals, therapeutic appliances and other goods and services whose primary intent is to contribute to the restoration or to the enhancement of the health status of the individual or population groups.
It includes household payments to public services, non-profit institutions and nongovernmental organizations. It also include none reimbursable cost sharing deductions, co-payments and fee-for-service,
but excludes payments by companies that deliver medical and paramedical benefits whether required by law or not, to the employee and also excludes payment for overseas treatmen’.
2 OOP expenditure on health has been observed through the years to be disproportionately higher among most developing countries than the developed ones.
REFERENCES
Soyibo A, Olaniyan O, Lawanson A.O. Incorporating sub-National Health Account
of States: National Health Account of Nigeria 2003 – 2005, Main Report
World Health Organization, Associated terms, out – of – pocket spending by private
households (OOPS): National Health Account, World Health Organization
Statistical Information System (WHOSIS) 2008
WHO Health Expenditure, WHO Health Statistics, Geneva, Switzerland, 2011
World Health Organization, Direct payment, where are we now? Universal
coverage, Health system financing, World Health report 2010, page 4.
Federal Ministry of Health, National Health Financing policy, Federal Republic of
Nigeria Introduction, 2006, pages 6-9.
World Health Organization, who pays for health, Health system financing
improving performance, World Health Report, Geneva, 2000, 95 – 97
