Towards Universal Coverage: Examining Costs of Illness, Payment, and Coping Strategies to Different Population Groups in Southeast Nigeria

Abstract

Abstract. This study investigated the costs of illness to households in different socio-economic status (SES) groups and geographic places of abode in addition to the mechanisms that the different population groups used to pay for health services and cope with payments. A cross-sectional descriptive study of 3,200 households selected from six communities in two states was conducted using interviewer-administered pre-tested questionnaires. An SES index was used to divide the households into quartiles, and χ 2 analysis was used to determine the relationship of SES and geographic abode of households with cost of illness, payment mechanism, and coping strategies. The results show that malaria was the illness that most people had. The average cost of transportation for malaria was 86 Naira ($0.6 US), and the total cost of treatment was 2,819.9 Naira ($20 US); of this cost, drug costs alone contributed more than 90%. Out of pocket was the main method of payment. Treatment costs differed by geographic location and socio-economic status. Policy measures should establish targeted mechanisms to protect the general population, especially rural dwellers and poorer households, against the financial burden of direct healthcare payments.

Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria

“…It could also disrupt children education. 1,31,32 The consequence can be enormous with poor health outcome, poverty, and sometimes death. Most of these are avoidable where there is a well-functioning prepayment scheme for health.…”

“…This is in agreement with findings in some previous studies. 1,24 Earlier works, 34,44 have made useful suggestions about technical design of health insurance such as frequency and amount of contribution that will suit different socioeconomic groups of people. Also innovative ways of fund-raising at the domestic level especially on goods purchased and services sought by the better -off in the society as a source of revenue collection to help the poor and the needy for a sustainable health-care financing scheme have been suggested.…”

“…The literature is deficient in studies on the cultural values that may influence the design of a prepayment system for residents of rural communities, particularly in Nigeria. 1,11,[23][24][25] Some studies on prepayment scheme from the southwest of Nigeria focused mainly on urban dwellers, 10,12,13 while none have been published about rural dwellers in the southwest of Nigeria. Thus, an assessment of these attributes among the potential beneficiaries of the scheme is a prerequisite to designing a culturally acceptable method of implementation that will also accommodate the socioeconomic situation of the people.…”

“…However, the majority of Nigerians still pay OOP for their health-care needs. [1][2][3][4] This method of payment is usually associated with non-utilization of health-care services, late presentation in health facilities, patronizing substandard health-care services, among others. OOP payment predisposes individuals and households to exhaust personal savings, borrow or loan money, sell properties and livestock, and sometimes pay by installments when permitted.…”

Self-reported illness and household strategies for coping with health-care payments in Bangladesh

“…We know relatively little about the strategies that households adopt to cope -or, at least, try to cope -with the financial costs of illness, and we have few data to show how such coping strategies affect the future welfare of the households that implement them. 10 In the few relevant studies that have been conducted, the coping strategies that are followed have been found to differ with the type of disease involved, 6,7,[11][12][13] with the sector (private or public) providing the outpatient facilities used, if any, 9,14 with the need for inpatient care, [14][15][16] and with the economic status of the patients or their households. 9,10,14,17 In Bangladesh, a country with high burdens of both noncommunicable and infectious diseases, out-of-pocket payments remain the most important source of funding for health care.…”