DETERMINANTS OF IMPOVERISHMENT DUE TO OUT OF POCKET PAYMENTS IN NIGERIA
Abstract
Background: Poverty is an extreme consequence of out of pocket payments in countries with health systems that do not provide financial risk protection through mandatory health insurance coverage for people in both the formal and informal sectors. The study assessed the determinants of impoverishment due to out of pocket payments in Nigeria. Methods: Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with impoverishment in Nigeria. Household and individual characteristics associated with impoverishment were determined using binary logistic regression. A significance level of p<0.05 was used. Results: Results show that lack of health insurance, having a member above 65 years, large household size, household socio-economic status, type of illness suffered, type of health facility visited, geo-political zones, education of household heads and location were major determinants of impoverishment due to out of pocket health expenditure. Conclusion: Findings from the study show that most households and individuals are vulnerable to financial risk due to this regressive source of payments for health care services. This explains why the level of poverty keeps increasing in spite of the numerous poverty alleviation programs across the country. Policy makers and political actors need to design a new health system financing policy that will increase financial risk protection for people in both the formal and informal sectors. Governments and decision makers have to focus on health as a determinant of economic well-being.Keywords: Out of pocket payments; Impoverishment; Harmonized Nigeria living standard survey; Financial risk protection; Health equityReferences
Rashad AS, Sharaf MF. Catastrophic economic consequences of health care payments: Effects on poverty estimates in Egypt, Jordan, and Palestine. Economies 2015;3(4):216–34.
Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff (Millwood) 2007;26(4):972–83.
WHO. The world health report: health systems financing: the path to universal coverage: executive summary. 2010.
Knaul FM, Wong R, Arreola-Ornelas H, Méndez O. Household catastrophic health expenditures: A comparative analysis of twelve Latin American and Caribbean Countries. Salud Publica Mex 2011;53(Suppl 2):S85–95.
Kwesiga B, Zikusooka CM, Ataguba JE. Assessing catastrophic and impoverishing effects of health care payments in Uganda. BMC Health Serv Res 2015;15:30.
McIntyre D. Learning from experience: health care financing in low and middle income countries. In Global Forum for Health Research. Geneva; 2007.
WHO. World Health Statistics 2014. Geneva; 2014.
Onoka CA, Onwujekwe OE, Uzochukwu BS, Ezumah NN. Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria. Health Res Policy Syst 2013;11:20.
WHO. World Health Statistics 2015. Geneva; 2015.
Nigeria Poverty Profile Report 2010. [Internet]. [cited 2016 Apr 4]. Available from: http://www.nigerianstat.gov.ng/pdfuploads/Nigeria%20Poverty%20Profile%202010.pdf
Nigeria - General Household Survey, Panel 2012-2013, Wave 2 - Overview [Internet]. [cited 2016 Apr 4]. Available from: http://microdata.worldbank.org/index.php/catalog/1952/study-description
McIntryre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low-and middle-income country contexts? Soc Sci Med 2006;62(4):858–65.
Whitehead M, Dahlgren G, Evans T. Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet 2001;358(9284):833–6.
Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ 2002;80(2):97–105.
Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D. Social capital, income inequality and mortality. Am J Public Health 1997;87(9):1491–8.
Narayan-Parker D, Patel R. Voices of the poor: can anyone hear us? Vol. 1. World Bank Publications; 2000.
WHO, Commission on Macroeconomics and Health. Investing in health: a summary of the findings of the Commission on Macroeconomics and Health. Geneva, Switzerland: World Health Organization, CMH Support Unit; 2003.
Ichoku HE, Fonta W, Onwujekwe O. Incidence and intensity of catastrophic health care financing and impoverishment due to out-of-pocket payments in southeast Nigeria. J Insur Risk Manag 2009;4(4):47–59.
Onwujekwe O, Hanson K, Uzochukwu B, Ichoku H, Ike E, Onwughalu B. Are malaria treatment expenditures catastrophic to different socio-economic and geographic groups and how do they cope with payment? A study in southeast Nigeria. Trop Med Int Health 2010;15(1):18–25.
Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu BS. Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries. Trop Med Int Health 2011;16(10):1334–41.
Onwujekwe O, Hanson K, Uzochukwu B. Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Health care Services and Health Facilities in Nigeria. PLoS One 2012;7(7):e40811.
Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, Torres A. Impoverishing and catastrophic household health spending among families with older adults in Mexico: A health reform priority. In: The Health of Aging Hispanics. Springer 2007;237–62.
Kabubo-Mariara J, Kirii DM, Ndenge GK, Kirimi J, Gesami RK. Regional and institutional determinants of poverty: The case of Kenya. Collaborative Project on Poverty, Income Distribution and Labour Market Issues in Sub-Saharan Africa. 2006.
Oyugi LN, Mwabu G, Masai W. The determinants of poverty in Kenya. Afr J Econ Policy 2000;7(1):47–64.
Geda A, de Jong N, Kimenyi MS, Mwabu G. Determinants of poverty in Kenya: A household level analysis. 2005. Economics working paper. [Internet]. [cited 2016 Apr 4]. Available from: http://digitalcommons.uconn.edu/econ_wpapers/200544
Mberu BU, Ciera JM, Elungata, P, Ezeh AC. Patterns and Determinants of Poverty Transitions among Poor Urban Households in Nairobi, Kenya. Afr Dev Rev 2014;26(1):172–85.
Van Minh H, Xuan Tran B. Assessing the household financial burden associated with chronic non-communicable diseases in a rural district of Vietnam. Glob Health Action 2012;5(1):18892.
Fissuh, E, Harris M. Modelling Determinants of Poverty in Eritrea: A New Approach. 2004. [Internet]. [cited 2016 Apr 4]. Available from: https://core.ac.uk/download/pdf/7358165.pdf?repositoryId=153
World Bank, Poverty Manual. Introduction to Poverty Analysis. World Bank Institute. 2005.[Internet]. [cited 2016 Apr 4]. Available from http://siteresources.worldbank.org/PGLP/Resources/PovertyManual.pdf
Mwabu G, Wafula M, Gesami R, Kirimi J, Ndeng'e G, Kiriti T, et al. Poverty in Kenya: Profiles and Determinants. Nairobi: Department of Economics, University of Nairobi and Ministry of Finance and Planning. Mimeo; 2000.
Ataguba J, Fonta W, Ichoku EH. The Determinants of Multidimensional Poverty in Nsukka, Nigeria. 2011.
Adepoju AO, Yusuf SA. Poverty and vulnerability in rural south west Nigeria. ARPN J Agric Biol Sci 2012;7(6):430–7.
Okojie CEE, World Institute for Development Economics Research. Gender and education as determinants of household poverty in Nigeria. Helsinki: UNU/WIDER; 2002.
Bogale A, Hagedorn K, Korf B. Determinants of poverty in rural Ethiopia. Q J Int Agric 2005;44(2):101–20.
Achia TN, Wangombe A, Khadiolo N. A logistic regression model to identify key determinants of poverty using demographic and health survey data. Eur J Soc Sci 2010;13(1):38–45.
Abuka CA, Atingi-Ego M, Opolot J, Okello P. Determinants of poverty vulnerability in Uganda. 2007.
Okurut FN, Odwee JO, Adebua A. Determinants of regional poverty in Uganda. Vol. 122. African Economic Research Consortium; 2002.
Audet M, Boccanfuso D, Makdissi P. The geographic determinants of poverty in Albania. Cah Rech Pap 2006;6:12.
Sekhampu TJ. Determinants of poverty in a South African Township. J Soc Sci 2013;34(2):145–53.
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