Research Article

ASSESSING OUT-OF-POCKET HEALTHCARE EXPENDITURE AND UTILIZATION IN NORTHWESTERN NIGERIA

Aminu Ma'aruf Nass1*, Adeleke Ismail Adedeji2
1 Department of Actuarial Science, Federal University Dutse, Dutse, P.M.B 7156, Jigawa State, Nigeria
2 Department of Actuarial Science & Insurance, University of Lagos, Akoka, Lagos, Nigeria
* Corresponding author: aminunass@fud.edu.ng
Published: Apr, 2025
Pages: 63-72

Abstract

This study investigates healthcare utilization and out-of-pocket (OOP) expenses across Nigeria's northwestern states. Using primary data from household surveys and secondary data on state healthcare budgets, the study employs the frequency method and generalised logit regression model, it examines socio-economic and demographic determinants affecting healthcare access and expenditure. Results reveal that households spend an average of 73,347.24 annually on healthcare, equivalent to 14.81% of their income, surpassing the CHE threshold of 10%. Jigawa and Kaduna states exhibit the highest CHE percentages, at 15.94% and 15.82%, respectively, while Zamfara records the lowest at 11.92%. Rural households bear greater financial strain due to limited health insurance coverage (19% compared to 50% in urban areas) and reliance on coping strategies such as borrowing or selling assets. The study underscores the need for policy reforms, including expanded health insurance, subsidized healthcare for vulnerable states, and improved budget efficiency. These measures are crucial to alleviating the financial burden of healthcare, addressing urban-rural disparities, and achieving equitable access to health services in the region.

Keywords

healthcare utilization; out-of-pocket expenses; health insurance coverage

References

  1. Abiiro, G.. A., & McIntyre, D. (2013). Universal financial protection through national health insurance: Astakeholder analysis of the proposed one-time premium payment policy in Ghana. Health Policy and Planning, 28(3), 263–278 .
  2. Adebisi, Y.. A., Alaran, A.. J., Okereke, M., Oke, G.. I., Ademola, P.. S., Simeon, O., & Lucero-Prisno, D.. E. (2020). Assessment of health budgetary allocation and expenditure toward achieving universal health coverage in Nigeria. International Journal of Health and Life Sciences, 6(2), e102552.
  3. Adeleke, I. (2025). Health care expenditures and financial burden across Nigeria's Northwestern states: An actuarial perspective. Journal of Economics, Finance and Management Studies, 8(5), 2604–2611.
  4. Adeleke, I. (2018). Developing a risk-adjusted capitation regime for Nigeria Health Insurance Scheme (NHIS). The Journal of Risk Management and Insurance, 22(2), 1–17.
  5. Adeleke, I., Hamadu, D., & Ibiwoye, A. (2012). Evaluation of the capitation regime of Nigeria Health Insurance Scheme. International Journal of Academic Research Part A, 4(5), 23–28.
  6. Adeyele, J. S., Ogungbenle, G. M., & Isimoya, O. A. (2019). Asymmetric information and health risk behavior in the National Health Insurance Scheme in Nigeria. Ekonomski horizonti, 21(2), 143-159.
  7. Adeyele, J. S., & Ogungbenle, G. M. (2019). Moral hazards and service delivery: Evidence from the National Health Insurance Scheme in Jos metropolis. Ife PsychologIAJournal, 27(2), 99-109.
  8. Akande, T.. M. (2012). Willingness to pay for community health insurance and its determinants among household heads in rural communities in North-Central Nigeria. International Review of Social Sciences and Humanities, 2(2), 133–142.
  9. Dallah, H., Adeleke, I. A., & Ben Oghojafor. (2018). Determinants of households' out-of-pocket health maintenance costs in Nigeria. Journal of Scientific Research and Development, 18(1), 25–36.
  10. Dalmlah, H., Adeleke, I. A., & Ben Oghojafor. (2017). Investigating the determinants of healthcare utilization in Nigeria. UNILAG Journal of Business, 3(1), 202–216.
  11. Ibiwoye, A., & Adeleke, I. A. (2009). Does national health insurance promote access to quality healthcare? Evidence from Nigeria. Geneva Papers on Risk and Insurance, 33, 219–233.
  12. Ibiwoye, A., & Adeleke, I. A. (2007). The impact of health insurance on healthcare provision in developing countries. Ghana Journal of Developmental Studies, 4(2), 48–58.
  13. Edeh, H. (2022). Exploring dynamics in catastrophic health care expenditure in Nigeria. Health Economics Review, 12(22).
  14. Onwujekwe, O., Hanson, K., & Uzochukwu, B.. (2012). Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria. PLOS ONE, 7(7), e40811.
  15. Piontkowski, J. (2019). Forecasting health expenses using a functional data model. Annals of Actuarial Science, 1–11.
  16. Powers, C.. A., Meyer, C.. M., Roebuck, M.. C., & Vaziri, B.. (2005). Predictive modeling of total healthcare costs using pharmacy claims data: Acomparison of alternative statistical methods. Medical Care, 43(11), 1065–1072.
  17. Simmons, M.. K., Federman, A.. D., Vlahiotis, A., & Kleinman, L.. C. (2018). Racial and ethnic differences in out-of-pocket expenses among adults with diabetes. Journal of the National Medical Association.
  18. Smith-Cavros, E., Avotri-Wuaku, J., Wuaku, A., & Bhullar, A. (2017). Oh, as for the health insurance… it's good, but…: Rural elders in Agate, Ghana, discuss the National Healthcare Insurance Scheme. Qualitative Research in Medicine & Healthcare, 1(1), 23–28.
  19. Hong, G., & Kim, S.. Y. (2000). Out-of-pocket healthcare expenditure patterns and financial burden across the lifecycle stages. The Journal of Consumer Affairs, 34(2), 291–313.
  20. Aregbeshola, B.. S., & Khan, S.. M. (2018). Out-of-pocket payments, catastrophic health expenditure, and poverty among households in Nigeria, 2010. International Journal of Health Management, 7(9), 798–806.
  21. Jong, P., & Heller, G.. Z. (2008). Generalized linear models for insurance data. Cambridge University Press.
  22. Kumara, A.. S., & Samaratunge, R.. (2016). Patterns and determinants of out-of-pocket healthcare expenditure in Sri Lanka: Evidence from household surveys. Health Policy and Planning, 31, 970–983.
  23. Lee, Y., & Nelder, J.. A. (2001). Hierarchical generalized linear models: A synthesis of generalized linear models, random-effect models, and structured dispersions. Biometrika, 88, 987–1006.
  24. Mehmud, S.. M., & Yi, R. (2012). Uncertainty in risk adjustment. Society of Actuaries' Health Section.
  25. NHIA(2022): National Health Insurance Act, 2022. Federal Republic of Nigeria Official Gazette, No. 95, Vol. 109.
  26. World Health Organization. (2014). Nigeria: Health account database. http://apps.who.int/nha/database
  27. WHO. (2022). The role of government in supporting health. https://www.who.int/tools/your-life-your-health/a-healthy-world/people-sroles/the-role-of-government-in-supportinghealth (accessed December 7, 2024).
  28. United Nations. (2015). Sustainable development. Department of Economic and Social Affairs. https://sdgs.un.org/goals (accessed December 7, 2024)
How to Cite

Nass, A. M., & Adedeji, A. I. (2025). ASSESSING OUT-OF-POCKET HEALTHCARE EXPENDITURE AND UTILIZATION IN NORTHWESTERN NIGERIA. Nigerian Actuarial Journal, 2(1), 63-72.

A. M. Nass, and A. I. Adedeji, "ASSESSING OUT-OF-POCKET HEALTHCARE EXPENDITURE AND UTILIZATION IN NORTHWESTERN NIGERIA," Nigerian Actuarial Journal, vol. 2, no. 1, pp. 63-72, April 2025.

Share this article:
Facebook X / Twitter LinkedIn
Download PDF View Full Text (PDF) Back to Articles