Variations in incidence out of pocket spending for illness amongst households of different socio-economic groups: An investigation using expenditure diaries

Abstract

Introduction: Where out-of-pocket payment (OOP) serves as the major means of financing health care, the cost of health care might  differentially influence health seeking behavior of households of different socio-economic status (SES) groups. This study examined the  variations in health care seeking and incidence and level of OOP across households of various SES groups.

Methodology: The study was carried out in south-east Nigeria. A pre-tested household diary was used to collect information from 1128  households over a period of one month. Household consumption expenditure data was used to disaggregate households into SES  quintiles. The incidence of spending on health care and the reasons for not spending when the household should have done so were  determined across SES quintiles. The levels of expenditure on healthcare and burden of OOPS were also compared across SES quintiles.

Results: The poorest households had the least incidence of spending on health care. The most common reason amongst the poorest  households for not spending on health care when they should have was the cost of health services while for the richest household, this  was because the illness was not considered serious enough. Households in the richest quintile representing 19.7% of the entire population accounted for 50.6% of the total expenditure on health while those in the second quintile and the poorest quintile accounted  for 9.9% and 6.4% of total health care expenditure respectively.

Conclusion: There is a wide gap between what poor and rich households  spend on health and with no financial protection mechanism, poor households might be forgoing needed health care. Policy makers  need to be persuaded that a shift away from out-of-pocket payment for health care which is inequitable and inefficient is necessary and  requires urgent attention.