Research
Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers
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* Corresponding author: Obinna Onwujekwe Obinna.Onwujekwe@unn.edu.ng
1 Health Policy Research Group, Dept of Pharmacology and Therapeutics, University of Nigeria Enugu-Campus, Enugu, Nigeria
2 Department of Health Administration and Management, University of Nigeria Enugu-Campus, Enugu
3 Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu
4 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
International Journal for Equity in Health 2011, 10:50 doi:10.1186/1475-9276-10-50
Published: 13 November 2011Abstract
Background
There is need for new information about the socio-economic and geographic differences in health seeking and expenditures on many health conditions, so to help to design interventions that will reduce inequity in utilisation of healthcare services and ensure universal coverage.
Objectives
The paper contributes additional knowledge about health seeking and economic burden of different health conditions. It also shows the level of healthcare payments in public and private sector and their distribution across socioeconomic and geographic population groups.
Methods
A questionnaire was used to collect data from randomly selected householders from 4,873 households (2,483 urban and 2,390 rural) in southeast Nigeria. Data was collected on: health problems that people had and sought care for; type of care sought, outpatient department (OPD) visits and inpatient department (IPD) stays; providers visited; expenditures; and preferences for improving access to care. Data was disaggregated by socio-economic status (SES) and geographic location (urban versus rural) of the households.
Results
Malaria and hypertension were the major communicable and non-communicable diseases respectively that required OPD and IPD. Patent medicine dealers (PMDs) were the most commonly used providers (41.1%), followed by private hospitals (19.7%) and pharmacies (16.4%). The rural dwellers and poorer SES groups mostly used low-level and informal providers. The average monthly treatment expenditure in urban area was 2444 Naira (US$20.4) and 2267 Naira (US$18.9) in the rural area. Higher SES groups and urbanites incurred higher health expenditures. People that needed healthcare services did not seek care mostly because the health condition was not serious enough or they could not afford the cost of services.
Conclusion
There were inequities in use of the different providers, and also in expenditures on treatment. Reforms should aim to decrease barriers to access to public and formal health services and also identify constraints which impede the equitable distribution and access of public health services for the general population especially for poor people and rural dwellers.