Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria
Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria
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DOI：
10.1186/1472-6963-10-67
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发表时间：
2010-03-17
影响因子：
2.8
通讯作者：
Okoli, Chijioke
中科院分区：
文献类型：
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作者：
Onwujekwe, Obinna E.;Uzochukwu, Benjamin S. C.;Okoli, Chijioke
背景：自付支出（OOPS）是尼日利亚医疗保健的主要支付策略。因此，本文评估了OOPS的决定因素社会经济地位（SES）和应对尼日利亚东南部城市、半城市和农村地区医疗保健支付的策略。本文提供的信息，将需要提高金融的可及性和公平性，在公共卫生保健system.Methods内的融资：研究领域是三个农村和三个城市地区，从Ebonyi和埃努古州东南部尼日利亚。本研究以随机抽样的住户为研究对象，采用访谈问卷进行横断面调查。一个社会经济地位（SES）指数，这是使用主成分分析被用来检查OOPS的不公平水平和回归分析被用来检查使用OOPS.Results的决定因素：所有的SES组同样寻求医疗保健时，他们需要。然而，最贫穷的家庭最有可能使用低级别和非正规的服务提供者，如传统治疗师，而最不贫穷的家庭更有可能使用高级别和正规的服务提供者，如保健中心和医院。富裕的社会经济地位群体比贫穷的社会经济地位群体更多地使用OOPS来支付医疗保健费用。使用自己的钱是三个社区最常见的支付应对机制。出售家庭动产或土地不常被用作应付付款的机制。社会经济地位的下降与家庭资产的销售增加，以科普支付医疗保健在一个社区。费用减免和补贴几乎是不存在的应对机制，在这项研究的结论：有必要减少OOPS和渠道，并通过设计和实施支付策略，将确保金融风险保护穷人，如预付机制与政府支付穷人改善公平的医疗融资。
Background: Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system.Methods: The study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS.Results: All the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this studyConclusions: There is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.