Out-of-Pocket Payment for Healthcare and Implications for Households: Situational Analysis in Yenagoa, Bayelsa State

Abstract

Background: Healthcare financing remains a critical issue in the on-going discourse on universal health coverage (UHC). This community-based study sought to examine the payment for healthcare and its relationship to indicators of catastrophic health expenditure (CHE) among households (HH) in Yenagoa.
Methods: Data was obtained from a cross-sectional survey of  households in two randomly selected communities in Yenagoa. A  pretested, structured, interviewer-administered questionnaire was used to obtain information on HH income, general expenditures and financing for healthcare. HH spending more than 10% total income and 40% non-food expenditure were deemed to have suffered CHE and both CHE thresholds were calculated for the sampled population and compared between payment modes.
Results: Responses were received from 525 HHs with median HH monthly income, total and healthcare expenditures of ₦115,000,  ₦112,170 and ₦9,250, respectively. Out-of-pocket (OOP) was the most prevalent (95.6%) mode of payment for healthcare. The incidence of CHE was 32.8% with reference to total income and 12.8% using non-food expenditure threshold. The Catastrophic Overshoots were 7% and -19.9% while Mean Positive Overshoots were 21% and 12% with respect to both thresholds for the entire study population. The  incidence of CHE was significantly higher in HHs with OOP than  insured HHs.
Conclusion: OOP was the main payment option for healthcare and exposes significantly higher proportion of HHs to CHE. Findings  support the need to expand the coverage of the social insurance scheme to reduce exposure to financial risks by HHs and achieve UHC in Yenagoa.

Keywords: Out-of-pocket; Healthcare financing; Catastrophic Health Expenditure; Households; Yenagoa; Nigeria.