Healthcare utilization patterns and financial coping mechanisms in rural communities of Delta State, Nigeria

Abstract

Healthcare services are essential for improving health status, prolonging life and promoting health and well-being, which is a fundamental requirement for living a socially and economically productive life. However, the utilization of healthcare services depends on several factors related to the health system and end users of the health facilities. This study aimed to assess healthcare utilization, payment methods, payment coping strategies and factors associated with healthcare utilization in selected rural communities of Delta State. It was a cross-sectional community-based study conducted among 412 household heads in four selected rural communities of Delta State using multistage sampling technique and a semi-structured interviewer administered questionnaire. Data analysis was done using the IBM SPSS statistics version 22 software and statistical significance was set at p < 0.05. Results obtained from the study reveal that the mean age of respondents was 50.44 (±14.50) years; 280 (68.0%) had used the health facilities while 132 (32.0%) had never used the health facilities in their locality. The most prevalent methods of payment for healthcare services were out-of-pocket cash payment (56.8%), followed by cash payment by employer (or reimbursed by employer) (16.4%), installment payment (15.7%), health insurance (2.5%) and in-kind payment (1.5%). The commonest payment coping strategies include payment with own money (73.9%), community solidarity / someone else paying (6.4%), selling family land (6.1%), borrowing/taking a loan (5.7%) and selling household movable assets (2.9%) etc. The significant factors associated with healthcare utilization were age (χ² =39.11; p<0.001), sex (χ²=31.65; p<0.001), marital status (χ²=18.95; p<0.001), education (χ² =36.59; p<0.001) and payment method (χ² =31.84; p<0.001) among others. Findings from this study revealed a relatively high rate of healthcare utilization in the study communities. However, the persistent challenges of Out-of-pocket spending, weak insurance coverage, socio-demographic and economic inequalities and payment mechanisms continue to hinder equitable access and utilization of healthcare services.