Out-of-pocket health expenditure: a preliminary survey of impact on households of patients in the intensive care unit of a tertiary hospital in Nigeria

Abstract

Background: Patients are often required to make direct out-of-pocket payments for medical care in hospitals in Nigeria. atients admitted into the Intensive Care Unit of the University of Port Harcourt Teaching Hospital from 1st July to 31st December 2008 recorded relationship to patient, payment pattern, household monthly income bracket, amount spent since admission, sources of funds for payment and effects of expenditure on households as well as effects of continued stay in the ICU. Results: Sixty-four relatives were interviewed out of 76 admissions. Representatives were spouses (34.4%), siblings (31.3%), children (18.8%), parents (12.5%) and colleagues (3.1%). Income brackets/month were: no income (12.5%), < N 50, 000 (65.6%), N 51–100,000(6.3%), N 101–150,000 (6.3%) and > N 200, 000 (9.4 %). Twenty-four households (37.5%) had spent < N 50,000.00, 30 (46.9%) had spent N 50–100,000, 10 (15.6%) had spent > N 100,000 since admission. Sources of funds were personal savings (48.4%), borrowing (40.6%), payment by employers (6.3%) and sale of assets (4.7%). Six households (9.4%) felt no impact of the expenditure at the time; but this was reduced to 4 (6.3%) with continued stay. Affected households reported financial hardships resulting in reduction in spending for other projects (31.3%), feeding difficulties (25.0%), inability to pay house rent (18.8%) and dropping out of school (15.5%). Conclusion: Direct out-of-pocket health expenditure by households of ICU patients causes depletion of personal savings and borrowing resulting in financial hardship.

Key words: Out-of-pocket health expenditure, intensive care patients, impact on households.