Impact and contributors to cost of managing long term conditions in a university hospital in Nigeria

Abstract

Background: Burden of long term non-communicable conditions in low and middle income countries are on the increase and poor access to care leaves poorer patients highly disadvantaged. This study assessed the contributors to cost and financial implications for patients being managed for hypertension and/or diabetes in a tertiary hospital in Nigeria.

Method: A descriptive cross-sectional study of 168 patients with long term conditions randomly selected from the medical clinics of a tertiary hospital. Data collection was done using a pre-tested, instrument. Disposable income as a measure of socioeconomic status (SES) index was used to stratified patients into quartiles. Contributors to cost of care, prevalence of catastrophic health expenditures (CHE) and risk of being impoverished as a result of cost of care were assessed. Statistical tests were used to explore relationships between the various variables.

Results: Costs of drugs and imaging techniques accounted for 56.79% and 31.62% respectively of the total average monthly cost of care. Majority (95.8%) of these patients relied on payment at the point of access, while only 4.2% were enrolled in pre-paid scheme. Overall, 72.6% of the respondents were exposed to CHE while 48.2% were likely to be impoverished due to the cost of managing their health condition.

Conclusion: Study found a high prevalence of catastrophic health expenditure and near absence of financial risk protection for patients with long term conditions. We recommend implementation of measures that would provide financial risk protection and improve access to care for patients with long term conditions.

Keywords: Cost Of Care, Long Term Conditions, Hypertension, Diabetes, Access, Nigeria