Determinants of Households Out-of-Pocket Health Maintenance Costs in Nigeria

Abstract

The rising out-of-pocket healthcare expenditures reflect changes in the healthcare market as businesses are increasing the employee-paid share of healthcare costs so that these costs fall back on the households. This article examines the determining factors for health maintenance costs. Generalised linear models were employed to determine the variation in health insurance coverage and out-of-pocket expenditures, using health maintenance households survey data. Results show that: family size, employer and income are the significant socio-economic determinants; insurance coverage and benefits from National Health Insurance Scheme are the health insurance contributors while consultation of care provider and affordability of prescription drugs are health maintenance determinants. Moreover, employer, income, regular use of prescription drugs, health insurance coverage, insurance awareness, benefits and policy affordability are causal determinants of health insurance coverage. Consequently, there is evidence that households, with health insurance coverage, have higher out-of-pocket expenditures, which is in contrast to the belief that insurance coverage reduces out-of-pocket expenses. Findings suggest the presence of moral hazards and adverse selection in the healthcare system, which calls for a risk-adjusted capitation regime taking into account households characteristics. Deliberate policy and strategies for reducing the burden of out-of-pocket expenses and addressing the variations resulting from the causal determinants should be instituted.