Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria

Abstract

Objective: To assess and compare how private and public health facilities patients cope with the economic burden of non-communicable diseases.
Design: Comparative cross-sectional study.
Setting: Thirty-nine private and eleven public health facilities in Ado-Ekiti, Nigeria
Participants: Three hundred and forty-eight (Private:173; Public:175) patients with hypertension or diabetes, or both were recruited.
Main Outcome Measures: Specific coping methods and numbers of coping strategies used by participants, as well as the perceived ability of participants to cope with the economic burden of non-communicable diseases.
Results: Majority of participants paid through out-of-pocket (OOP) than through health insurance(HI) (Pri-vate:OOP:90.2% HI:9.8%; Public:OOP:94.3% HI:5.7%; p=0.152). More participants in private used instalment payments(p<0.001). However, other coping strategies showed no significant difference in both groups(p>0.05). Delayed treatment (Private:102; Public:95) was the most used strategy in both arms, and the number of strategies used by the participants showed no significant difference(p=0.061). Lower levels of education, out-of-pocket payment, increasing number of clinic visits, and hospital admission were associated with the use of higher numbers of coping strategies in both groups while being female and retired/unemployed were associated with the private arm.
Conclusion: Although most patients in both groups pay out-of-pocket and use detrimental coping strategies, more patients in private arm use installment payment, a non-detrimental method. Healthcare providers, especially public providers, should adopt policies encouraging patients to use non-detrimental coping strategies to meet their healthcare expenditures.