Risk and determinants of catastrophic health expenditure among rural households in rivers state

Authors

  • Fredrick C. Enuagwuna Department of Preventive and Social Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria
  • Daprim S. Ogaji Department of Preventive and Social Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria
  • Oghenerukevwe Tebu Epidemiology Division, University of Port Harcourt School of Public Health, Choba, Rivers State, Nigeria

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20234111

Keywords:

CHE, Incidence, Determinants, Rural areas, Rivers State

Abstract

Background: Concerns about how the expense of healthcare impacts rural families' ability to pay their bills are rising, especially in environments where prepayment systems are inadequate and people pay cash while using health services. This research evaluated the method of payment, frequency, and contributing factors of catastrophic health expenditure (CHE) among rural inhabitants of Rivers State.

Methods: This retrospective longitudinal study was conducted among 450 inhabitants in six rural communities in Rivers State. The participants were chosen using a multistage sampling process. A validated semi-structured questionnaire which was interviewer administered was used to obtain the data. IBM statistical package for the social sciences version 25 was used to analyze the data. Data were summarized using means, frequency, and proportions while bivariate and multivariate binary logistic regression were used to explore determinants of CHE with p≤0.05 considered statistically significant.

Results: The result showed that 94.9% of rural households pay for health care via out-of-pocket payment and 88.4% rural residents experience catastrophic health payment. Household income of less than N100,000 (AOR=2.8, 95% C.I.=1.4-5.4, p=0.002) and having two or more dependents (AOR=3.3, 95% C.I.=1.3-8.0 p=0.002) were determinants of CHE.

Conclusions: There is need to increase public funding for healthcare as well as expand the coverage of the NHIS to mitigate the effect of health care cost on rural residents in Rivers State. 

 

References

Li Y, Wu Q, Liu C, Kang Z, Xie X, Yin H et al. Catastrophic health expenditure and rural household impoverishment in China: What role does the new cooperative health insurance scheme play? PLoS One. 2014;9(4).

Li Y, Wu Q, Xu L, Legge D, Hao Y, Gao L et al. Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull World Health Organ. 2012;90(9):664-71.

Aregbeshola BS, Khan SM. Determinants of catastrophic health expenditure in Nigeria. Eur J Health Econ. 2018;19(4):521-32.

Financial toxicity associated with treatment of localized prostate cancer. Nature Reviews Urology. 2020;17:28-40.

Knaul FM, Wong R, Arreola-Ornelas H, Econ MH, Méndez O, Bitran R et al. Household catastrophic health expenditures: A comparative analysis of twelve latin American and Caribbean countries. Salud Publica Mex. 2013;53(2):85-95.

Adewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria. Am J Trop Med Hyg. 2015;93(3):648-54.

Edeh HC. Exploring dynamics in catastrophic health care expenditure in Nigeria. Health Econ Rev. 2022;12(1):22.

Liu H, Zhu H, Wang J, Qi X, Zhao M, Shan L et al. Catastrophic health expenditure incidence and its equity in China: A study on the initial implementation of the medical insurance integration system. BMC Publ Heal. 2019;19(1):1-12.

Asante A, Price J, Hayen A, Jan S, Wiseman V. Equity In Health care financing in low-and middle-income countries: A systematic review of evidence from studies using benefit and financing incidence analyses. PLoS One. 2016;11(4):1-20.

Kabia E, Goodman C, Balabanova D, Muraya K, Molyneux S, Barasa E. The hidden financial burden of healthcare: a systematic literature review of informal payments in Sub-Saharan Africa. Wellcome Open Res. 2021;6:297.

Sowmithra V, Maiya G, Jain T. Pattern of Out of Pocket Healthcare Expenditure and Prevalence of Catastrophic Health Expenditure in Patients Attending a Tertiary Hospital in Chennai. Ann Trop Med Publ Heal. 2020;23(23).

Hafez R. Nigeria Health Financing System Assessment. Washington, DC: World Bank; 2018. Available at: https://openknowledge.worldbank.org/handle/10986/30174. Accessed on 24 January, 2023.

PWC. Sustainability of State Health Insurance Schemes in Nigeria: Beyond the launch. 2019.

Rodrigues JARM, Cunha ICKO, Vannuchi MTO, Haddad M do CFL. Out-of-pocket payments in hospital bills: a challenge to management. Rev Bras Enferm. 2018;71(5):2511-8.

Farahat TM, Shaheen HM, Khalil NA, Basma S, Ibrahem. Out-of-pocket health expenditure in rural population. Menoufia Med. 2018;31(3):846-9.

Attia-Konan AR, Oga ASS, Touré A, Kouadio KL. Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d’Ivoire. BMC Res Notes. 2019;12(1):25.

Adesina AD, Ogaji DS. Out-of-Pocket Payment for Healthcare and Implications for Households: Situational Analysis in Yenagoa, Bayelsa State. J Community Med Prim Health Care. 2020;32(1):1-16.

Aregbeshola BS, Khan SM. Original Article Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria. Int J Health Policy Manag. 2018;7(9):798-806.

Sataru F, Twumasi-Ankrah K, Seddoh A. An Analysis of Catastrophic Out-of-Pocket Health Expenditures in Ghana. Front Health Serv. 2022;2:1-9.

Akinkugbe O, Chiliba C, Setshegetso N. Health Financing and Catastrophic Payments for Health Care: Evidence from Household-level Survey Data in Botswana and Lesotho. Afr Dev Rev. 2012;24(4):358-70.

Khemiri K. Decomposing inequality in catastrophic health expenditure in Tunisia: which differences between rural and urban women after the 2007 reform. J Health Med Res. 2020;S(5):13.

Ravangard R, Jalali FS, Bayati M, Palmer AJ, Jafari A, Bastani P. Household catastrophic health expenditure and its effective factors: a case of Iran. Cost Eff Resour Alloc CE. 2021;19:59.

Swetha NB, Shobha S, Sriram S. Prevalence of catastrophic health expenditure and its associated factors, due to out-of-pocket health care expenses among households with and without chronic illness in Bangalore, India: A longitudinal study. J Prev Med Hyg. 2020;61(1):E92-7.

Ahmed S, Ahmed MW, Hasan MZ, Mehdi GG, Islam Z, Rehnberg C et al. Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: Evidence from the nationwide Household Income and Expenditure Survey 2016. Int Health. 2022;14(1):84-96.

Ajayi PO, Ibirongbe DO, Ipinnimo TM, Solomon OO, Ibikunle AI, Obiagwu AE. The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison. J Health Med Sci. 2021;4(2).

Mulaga AN, Kamndaya MS, Masangwi SJ. Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi. PLoS One. 2021;16(3):e0248752.

Duan W, Zhang W, Wu C, Wang Q, Yu Y, Lin H et al. Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study. BMJ Open. 2019;9(4):e026638.

Virdis J, Eugenia Elorza M, Delbianco F. Financial protection from health care spending in Argentina: evolution and distribution (1985-2018). Stud Appl Econ. 2022;40(2).

Eze P, Lawani LO, Agu UJ, Amara LU, Okorie CA, Acharya Y. Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review. PLOS One. 2022;17(10):e0276266.

Ajayi PO, Ipinnimo TM, Esan DT, Solomon OO, Moronkeji T. Determinants of catastrophic health spending among rural households in Nigeria. Niger Health J. 2022;22(3):278-87.

Abdel-Rahman S, Shoaeb F, Fattah MNA, Abonazel MR. Predictors of catastrophic out-of-pocket health expenditure in rural Egypt: application of the heteroskedastic probit model. J Egypt Public Health Assoc. 2021;96(1):23

Department of Economic and Social Affairs UN. Designing Household Survey Samples: Practical Guidelines. 2005.

Oyefabi AdegboyegaO, Aliyu AlhajiA, Idris A. Sources of health care financing among patients at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. J Med Trop. 2014;16(1):27.

Sun CY, Shi JF, Fu WQ, Zhang X, Liu GX, Chen WQ et al. Catastrophic Health Expenditure and Its Determinants Among Households With Breast Cancer Patients in China: A Multicentre, Cross-Sectional Survey. Front Public Health. 2021;9.

Lawal A, Gobir A, Aliyu A, Sufiyan M, Olorukooba A, Amadu L, et al. Community-Based Health Insurance Scheme In A Rural Community Of North West Nigeria: A Roadmap To Achieving Universal Health Coverage. Kanem J Med Sci. 2020;14(2):124-30.

Anyanwu JC. Marital Status, Household Size and Poverty in Nigeria: Evidence from the 2009/2010 Survey Data. Afr Dev Rev. 2014;26(1):118-37.

Azzani M, Roslani AC, Su TT. Determinants of household catastrophic health expenditure: A systematic review. Malays J Med Sci. 2019;26(1):15-43.

Ogaji DS, Adesina, AD. The predictors of Catastrophic health expenditure among households in Yenegoa, Bayelsa State. Nig Med J. 2018;2(1):9-23.

Ogaji DS, Nwi-ue LB, Agalah HN, Ibok SG, N-ue DM. Impact and contributors to cost of managing long term conditions in a university hospital in Nigeria. J Community Med Prim Health Care. 2015;27(2):30-40.

United Nations. Social protection in rural areas: achieving universal access for all. Available at: https://www.un.org/development/desa/dspd/2021/05/social-protection-in-rural-areas/. Accessed on 10 March, 2023.

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Published

2023-12-30

How to Cite

Enuagwuna, F. C., Ogaji, D. S., & Tebu, O. (2023). Risk and determinants of catastrophic health expenditure among rural households in rivers state. International Journal Of Community Medicine And Public Health, 11(1), 79–86. https://doi.org/10.18203/2394-6040.ijcmph20234111

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Original Research Articles