Economic Burden and Out-Of-Pocket Health Expenditure for Quality Healthcare Services in a Nigerian Tertiary Healthcare Facility in the South East Nigeria.

Abstract

The increasing cost of healthcare services globally has placed a significant financial burden on households, particularly in low- and middle-income countries where health insurance coverage remains inadequate. Out-of-pocket expenditure (OOPE) has emerged as a critical issue, as patients and their families often bear the direct costs of medical treatments, medications, and associated non-medical expenses. Unlike systems where healthcare is funded through taxation or insurance, OOPE exposes individuals to financial distress, with many facing catastrophic health expenditures that push them into poverty. In Nigeria, healthcare financing is predominantly structured on a "cash-and-carry" basis, where patients must pay directly for services at the point of care. This system disproportionately affects low-income populations, who may forgo necessary treatments due to financial constraints. Despite government efforts to introduce health insurance schemes, such as the National Health Insurance Scheme (NHIS), coverage remains limited, leaving a substantial portion of the population reliant on OOPE. In an effort to address the lack of financial risk protection, the Federal Government of Nigeria launched the National Health Insurance Scheme (NHIS) in 2005 with the goals of ensuring that households are protected from the financial burden of out-of-pocket health payments and that access to quality healthcare services is made possible. The majority of low- and middle-income countries (LMICs), including Nigeria, are grappling with the issue of poverty. Financial protection ensures that households do not face financial hardship and become impoverished as a result of seeking healthcare. The National Health Insurance Scheme (NHIS) was introduced to provide social health insurance (SHI) to Nigerians and ensure Universal Health Coverage (UHC). (WHO; 2010). However, according to the National Insurance Scheme (2019), federal government employees are the only ones required to participate in the NHIS programs, which fall under the categories of Formal Sector, Informal Sector, and Vulnerable Sector. In contrast, state government employees are not legally aentitled to be beneficiaries