Inequities in Household Out-Of-Pocket Spending Among Urban Slum Dwellers in Southeast Nigeria.

IF 2.4 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International Journal of Public Health Pub Date : 2025-03-27 eCollection Date: 2025-01-01 DOI:10.3389/ijph.2025.1607969

Okechukwu Ozor, Chukwudi Nwokolo, Noemia Teixeira de Siqueira Filha, Aloysius Odii, Joseph Paul Hicks, Shushan Li, Uchenna Ezenwaka, Bryony Dawkins, Obinna Onwujekwe

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引用次数: 0

Abstract

Objectives: This study examines the economic burden and inequities in out-of-pocket expenditures (OOPEs) to access healthcare in urban slums in Nigeria.

Methods: The cross-sectional study was undertaken in eight urban slums in Enugu and Anambra, Nigeria. Participants (n = 1,025) responded to questions on health expenditures and access to healthcare. Gamma regression was used to estimate the mean differences in OOPE. Financing incidence analysis was used to estimate inequities in OOPE.

Results: Enugu residents and individuals with formal occupations incurred lower costs than the residents in Anambra and those employed in informal occupations. Households in the middle wealth quintile incurred higher costs than those in the poorest quintile. Gini, concentration, and Kakwani indices indicated a progressive financing system, with the richest contributing proportionately more than their share of ability to pay (ATP). Poorest households used informal healthcare more.

Conclusion: Although payment for healthcare in urban slums is progressive, the poorest households may be at risk of poor health outcomes due to reliance on informal healthcare providers. Our findings highlight the role ATP may play in healthcare denial among the urban poor.

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尼日利亚东南部城市贫民窟居民家庭自付支出的不平等。

目的：本研究考察了经济负担和不公平的自付支出（OOPEs）在尼日利亚的城市贫民窟获得医疗保健。方法：在尼日利亚埃努古和阿南布拉的8个城市贫民窟进行横断面研究。参与者（n = 1,025）回答了关于保健支出和获得保健的问题。采用伽玛回归估计OOPE的平均差异。融资发生率分析用于估计OOPE的不公平。结果：埃努古居民和从事正规职业的个体的成本低于阿南布拉居民和从事非正规职业的个体。中等财富五分之一的家庭比最贫穷的五分之一的家庭承担了更高的成本。基尼系数、集中度和Kakwani指数表明了一个渐进的融资体系，最富有的人的贡献按比例超过了他们的支付能力（ATP）。最贫困家庭更多地使用非正规医疗保健。结论：尽管城市贫民窟的医疗保健支付是渐进式的，但由于依赖非正式医疗保健提供者，最贫困家庭可能面临健康状况不佳的风险。我们的研究结果强调了ATP可能在城市穷人拒绝医疗保健中发挥的作用。

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来源期刊

International Journal of Public Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.20

自引率

2.20%

发文量

269

审稿时长

12 months

期刊介绍： The International Journal of Public Health publishes scientific articles relevant to global public health, from different countries and cultures, and assembles them into issues that raise awareness and understanding of public health problems and solutions. The Journal welcomes submissions of original research, critical and relevant reviews, methodological papers and manuscripts that emphasize theoretical content. IJPH sometimes publishes commentaries and opinions. Special issues highlight key areas of current research. The Editorial Board''s mission is to provide a thoughtful forum for contemporary issues and challenges in global public health research and practice.