Prevalence of out-of-pocket health expenditure among artisans in Rivers State, Nigeria

Abstract

Background/Objectives: A significant barrier to accessing healthcare in Nigeria is the requirement for payment at the point of service. Out-of-pocket (OOP) payments, the primary method of healthcare financing, have created substantial challenges in obtaining medical care. This research explored the socio-economic status of artisans in relation to OOP payments and how these factors have impacted their ability to access healthcare services in Rivers State, Nigeria. Design/Methods: The study utilized a cross-sectional, household-based design to determine household OOP expenditures on healthcare within the community. Data were collected using structured, closed-ended, interviewer-administered questionnaires distributed to 598 eligible artisans or their representatives, selected through a multistage random sampling technique. The Pearson Chi-square test was applied to analyze the association between OOP payments and other categorical variables, while logistic regression was employed to assess the multivariate relationship of OOP payments. Results: Among the 598 artisans surveyed, nearly all participants (98.2%) paid directly for healthcare services, with only 1.8% utilizing health insurance, particularly through the National Health Insurance Scheme (NHIS). On average, households spent 6.22% of their income on healthcare. Lower-income groups spent disproportionately more on healthcare compared to wealthier groups and their expenditures were more likely to be catastrophic. Conclusion: The primary barrier to accessing healthcare was out-of-pocket payments, driven by the lack of social health insurance or other forms of healthcare coverage. Expanding the National Health Insurance Scheme and introducing a Community-Based Social Health Insurance Program is urgently needed to address the needs of those in the informal sector.