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Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria

Open access
Onwujekwe, Obinna, Hanson, Kara, Uzochukwu, Benjamin·2012·PLoS ONE
DOI 10.1371/journal.pone.0040811PMC PMC3397929
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Abstract

OBJECTIVE: There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. METHODS: The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. RESULTS: The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. CONCLUSION: The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.

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  • In southeast Nigeria, where Imo State is located, 27% of households incur catastrophic health expenditures, and this rate was higher for rural regions and for people with a mental illness.

    “In southeast Nigeria (where Imo State is located), 27% of households incur catastrophic health expenditures, and this rate was higher for rural regions and for people with a mental illness (factoring in both direct and indirect costs of the illness) [65–67].”

    From Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project (2022) · cites this paper as [65]

    The Abstract Results report that 27% of sampled households incurred catastrophic health expenditures, with a higher rate among rural residents. The Methods (Research Area) place the study in selected areas of Enugu and Anambra states, not Imo State, so the figure is not an estimate for all of southeast Nigeria. The paper does not report a higher rate among people with mental illness or an analysis factoring in both direct and indirect costs of mental illness. (LLM, conf=0.90)

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Research works printed but not linked: 2

  1. 2011, Key issues from the 2011 AfHEA conference: Toward universal health coverage in Africa.
  2. HE Ichoku, 2009, Incidence and intensity of catastrophic healthcare financing and impoverishment due to out-of-pocket payments in southeast Nigeria., Journal of Insurance and Risk Management, 4(4), 47

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Metadata

Authors
Onwujekwe, O., Hanson, K., & Uzochukwu, B.
Affiliations
  • University of Nigeria (NG)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Onwujekwe, Obinna
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2012-07-16
Volume
7
Issue
7
Pages
e40811
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0040811
PMC
PMC3397929
OpenAlex
W2085315204
Cited by
116
References
29
Citations by year
2026: 8 · 2025: 7 · 2024: 2 · 2023: 5 · 2022: 14 · 2021: 15 · 2020: 16 · 2019: 16 · 2018: 6 · 2017: 4 · 2016: 8 · 2015: 6 · 2014: 5 · 2013: 4
FWCI
7.97
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Department for International Development
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
Keywords
catastrophic health expenditure, socioeconomic disparities, household health expenditure, outpatient care, inpatient services, urban-rural differences, health insurance coverage, financial protection, universal health coverage, Nigeria
MeSH terms
Adult, Health Expenditures, Family Characteristics, Female, Health Facilities, Health Services, Humans, Insurance, Health, Male, Nigeria, Patient Acceptance of Health Care, Risk, Socioeconomic Factors, Incidence

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