Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study

Aim This study estimated out-of-pocket health-care spending and its determinants among households in Nigeria. Methods Using secondary data from the 2009/2010 Harmonized Nigeria Living Standard Survey, we estimated the determinants of out-of-pocket health-care spending in Nigeria. The Heckman two-step selection model was used to analyse household and individual decisions to seek care and how much to spend on health care. Data were analysed using STATA version 12 software. Results Results from the Heckman selection model indicated that having household heads with primary education, having household heads with secondary education, having more than five members in the household, households residing in the South East region, having head of the household being employed, households visiting public health facilities, and having household members with chronic illnesses were factors that increased the likelihood of incurring out-of-pocket health-care spending. Conclusion Our findings suggest that individual and household characteristics increase the risk of incurring out-of-pocket health-care spending. Policy makers and political actors need to stop the high reliance on out-of-pocket health-care spending as a means of financing the Nigerian health system by increasing public health expenditure. The design and implementation of a tax-based non-contributory health financing system for the poor, vulnerable, and informal sector workers would be more helpful for implication at a national level.