Okechukwu Ozor, Chukwudi Nwokolo, Noemia Teixeira de Siqueira Filha, Aloysius Odii, Joseph Paul Hicks, Shushan Li, Uchenna Ezenwaka, Bryony Dawkins, Obinna Onwujekwe
{"title":"尼日利亚东南部城市贫民窟居民家庭自付支出的不平等。","authors":"Okechukwu Ozor, Chukwudi Nwokolo, Noemia Teixeira de Siqueira Filha, Aloysius Odii, Joseph Paul Hicks, Shushan Li, Uchenna Ezenwaka, Bryony Dawkins, Obinna Onwujekwe","doi":"10.3389/ijph.2025.1607969","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the economic burden and inequities in out-of-pocket expenditures (OOPEs) to access healthcare in urban slums in Nigeria.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":14322,"journal":{"name":"International Journal of Public Health","volume":"70 ","pages":"1607969"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981907/pdf/","citationCount":"0","resultStr":"{\"title\":\"Inequities in Household Out-Of-Pocket Spending Among Urban Slum Dwellers in Southeast Nigeria.\",\"authors\":\"Okechukwu Ozor, Chukwudi Nwokolo, Noemia Teixeira de Siqueira Filha, Aloysius Odii, Joseph Paul Hicks, Shushan Li, Uchenna Ezenwaka, Bryony Dawkins, Obinna Onwujekwe\",\"doi\":\"10.3389/ijph.2025.1607969\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This study examines the economic burden and inequities in out-of-pocket expenditures (OOPEs) to access healthcare in urban slums in Nigeria.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":14322,\"journal\":{\"name\":\"International Journal of Public Health\",\"volume\":\"70 \",\"pages\":\"1607969\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-03-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981907/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/ijph.2025.1607969\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Public Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/ijph.2025.1607969","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Inequities in Household Out-Of-Pocket Spending Among Urban Slum Dwellers in Southeast Nigeria.
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.
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.
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