Out-of-Pocket Spending and Access to Healthcare Services in Sokoto, Nigeria

Abstract

Background: User fees paid through out-of-pocket spending (OOPS) impede access to healthcare services, particularly among the poor. The study aimed to assess the households’ pattern of out-of-pocket spending, predictors of access to healthcare, and to explore their socio-economic (SES) status differences in paying for their healthcare. Methodology: This was a descriptive cross-sectional study design. The instrument was a pre-tested, semi-structured interviewer-administered the questionnaire. Association between variables was assessed using the chi-square test and logistic regressions at a <.05. Results: The mean age of respondents was 41.7 ± 12.6 years. Generally, 94% of payments were made through ‘formal’ out-of-pocket spending (user-fees) with most respondents having to source for funds from own money (90.5%). Households in the lower social class were more likely to pay for their healthcare through OOPS (X2 = 11.4, p = 0.001) and often patronized traditional care and PHC. User-fees and lower social class were significant predictors of poor access to healthcare. Conclusion: This study brought to the fore that user-fees (or formal OOPS) negatively impacts on the access to healthcare services at the health facilities. The Federal Government should explore and other sources of financing that are efficient, equitable, fair and sustainable like the Community-Based Insurance Scheme (CBIS) and National Health Insurance Scheme (NHIS) and also increase investment and public spending on health.