Healthcare Financing in Nigeria: The Analysis of the Inequity Perspective
DOI:
https://doi.org/10.24203/ajhss.v7i3.5795Keywords:
Equity, Out of Pocket, healthcare financing, poor and non-poorAbstract
The volume and quality of healthcare needs vary from one individual to another but promoting access to the use of healthcare is germane to reduce/eliminate inequity in healthcare. This paper examines the extent of equity in healthcare financing in Nigeria, and determine the relative progressivity of each source of healthcare financing in the country using waves 2 and 3 of the General Household Survey. Kakwani and Modified Kakwani (MDK) indexes were used to estimate progressivity of out of pocket payment (OOP) and social health insurance. Overall result indicates a vertical inequity favouring the non-poor (pro-rich), OOP as a source of financing was regressive and social health insurance was moderately progressive. Given that a more progressive healthcare financing approach tends to promote welfare and improve health status of the population, Nigeria will be better off promoting health insurance as a means of eliminating inequity in healthcare financing.
References
Krutilova V. 2013. Cost sharing of patients for healthcare – forms, extent, impacts.
Mahapatro, M. 2013. Equity in utilization of healthcare services: Perspective of pregnant women in southern Odisha, India. National Institute of Health & Family Welfare, New Delhi, India.
O’Donnell.O.,Van Doorslaer, E., Wagstaff, A. and Lindelow, M. 2008. Analyzing Health Equity Using Household Survey Data:A Guide to Techniques and Their Implementation. The International Bank for Reconstruction and Development / The World Bank.
Lagarde M. and Palmera N.2008. The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? Bulletin of the World Health Organization.
Abu-Zaineh Mohammad,Chokri Arfa,Bruno Ventelou,Habiba Ben Romdhane and Jean-Paul Moatti 2013. Fairness in healthcare finance and delivery: what about Tunisia?
Dalal, K., Aremu, O., Ussatayeva, G. and Biswas, A. 2017. Out of pocket Expenditure and Fairness in Utilization of Health care Facilities in 2005 and 2010. [version 1; referees: 2 approved] F1000Research 6:2066 (doi:10.12688/f1000research.12801.1).
Business Monitor International (BMI) Report 2015.
Cissé, B., Luchini, S. and Jean Paul Moatti 2009. Equity in Healthcare Finance and and Delivery :What about Africa ?
Emshaw, D. 2010. Inequality and inequity in physician service utilization in Norway.
Olaniyan, O., C. S. Oburota and F. N. Obafemi 2013. Equity in Healthcare Expenditure in Nigeria. International Journal of Finance & Banking Studies, (2)3 2147-4486 available online at www.ssbfnet.com.
Teresa Bago d’Uvaa, Andrew M. Jones, Eddy van Doorslaer 2009. Measurement of horizontal inequity in health care utilisation using European panel data. Journal of Health Economics 28 (2009) 280–289
Lorant V., Boland B. , Humblet P. and Deliege D. 2002. Equity in prevention and healthcare. J Epidemiol Community Health, 56: 510–516.
Mohammad Abu-Zaineh, Awad Mataria, Ste´phane Luchini and Jean-Paul Moatti 2008. Equity in health care financing in Palestine: The value-added of the disaggregate approach. Social Science & Medicine 66 (2008) 2308-2320.
O’Donnell O, Eddy van Doorslaer, Ravi P. Rannan-Eliya, Aparnaa Somanathan, Shiva Raj Adhikari, Baktygul Akkazieva, Deni Harbianto ,Charu C. Garg, Piya Hanvoravongchai, Alejandro N. Herrin, Mohammed N. Huq, Shamsia Ibragimova, Anup Karan, Soon-man Kwon, Gabriel M. Leung, Jui-fen Rachel, Yasushi Ohkusa, Badri Raj Pande, Rachel Racelis, Keith Tin, Kanjana Tisayaticom, Laksono Trisnantoro, Quan Wan, Bong-Min and Yuxin Zhao (2005). Who pays for healthcare in Asia?. EQUITAP Project: Working Paper #1.
Ichoku, Fonta and Araar 2011. A Distributional Analysis of out-of-pocket Healthcare Financing in Nigeria Using a New Decomposable Gini Index. Journal of Applied Statistics 1(1): 65-77.
World Development Indicators 2017.
NHSMS report, 2015).
National Population Commission 2013. Nigeria Demographic and Health Survey (NDHS) 2103 (preliminary report). Abuja, Nigeria :NPC
USAID 2017. https://www.usaid.gov/nigeria/global-health
Kharas, H., Kristofer H. and Martin H. 2018. The Start of a New Poverty Narrative. World Bank’s Brooking Institute 2018 Report.
Glied, S. A. 2008. Health Care Financing, Efficiency and Equity. National Bureau of Economic Research . Working paper 13881 available in http:// www.nber.org/papers/w13881
Gravelle, H. , S.Morris and M. Sutton 2006. Economic studies of equity in the consumption of healthcare. The Elgar Companion to Health Economics. 193-204.
Wagstaff Adam and Eddy Van Doorslaer 1998. Equity In Healthcare Finance And Delivery. Second Draft Prepared for Chapter 40, North Holland Handbook of Health Economics, (eds.) AJ Culyer and JP Newhouse.
Sen Amartha (1992) Inequality Re-examined. Oxford: Clarendon Press.
Neill Jon R. (2000). The benefit and sacrifice principles of taxation: A synthesis Social Choice. Journal of Social Choice Welfare 17:117-124.
Kakwani, C.N. 1977.Measurement of Tax Progressivity International comparison. The Economic Journal*****.
Reynolds, M., and Smolensky, E. 1977. Public expenditures, taxes, and the distribution of income: The United States, 1950, 1961, 1970. New York: Academic Press.
Fukushige M., Ishikawa N. and Maekawa S. 2012. Modified Kakwani Measure for Health Inequality. Health Economics Review 2012 2:12. http://www.healtheconomicsreview.com/content/2/1/10
Suits D.B. 1977. Measurement of tax progressivity. The American Economic Review 67 (4): 747-752
Atkinson, A. B. 1980. Horizontal Equity and the Distribution of Tax Burden.
Plotnick, R.D., (1981). A measure of horizontal equity. Review of Fconomics and Statistics 63,283-288.
Plotnick, RD., 1982. The concept and measurement of horizontal equity. Journal of Public Economics 17, 373-391.
Berliant, M.C. and Strauss, R.P. 1983. Measuring the Distribution of Personal Taxes.
Berliant, M.C. and Strauss, R.P. 1985. The Horizontal and Vertical Equity Characteristics of the Federal Individual Income Tax 1966-1977.
Kaplow, L. 1989. Horizontal Equity: Measure in Search of a Principle. National Tax Journal 42:139-154.
Slenick, D.T. 1989. The Measurement of Horizontal Inequality. Review of Economics and Statistics 71:481-490.
Onwujekwe, O., Chima Onoka, Benjamin Uzochukwu and Kara Hanson 2011. Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers .International Journal for Equity in Health 10(50): 1-9. http://www.equityhealthj.com/content/10/1/50
Ewelukwa, O., C. Onoka and O. Onwujekwe 2013. Viewing health expenditures, payment and coping mechanisms with an equity lens in Nigeria. BMC Health services research 13:87 http://www.biomedcentral.com/1472-6963/13/87
Mitei,G. S. Makawia, M. Ally, A. Kuwawenaruwa,F. Meheus and J. Borghi 2012. Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania. Health Policy and Planning 2012;27:i23–i34.
Mills, A., J.E. Ataguba, J. Akazili, Jo Borghi, B. Garshong, S. Makawia, G. Mtei, B. Harris, J. Macha, F. Meheus and Di McIntyre 2012. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage.
Akazili,J., B. Garshong, M. Aikins, J. Gyapong and Di McIntyre 2012. Progressivity Of Health Care Financing And Incidence Of Service Benefits In Ghana. Health Policy and Planning 27:i13–i22 doi:10.1093/heapol/czs004
Chai Ping Yu, Whynes, K. and Sach, H. 2008. Equity in health care financing: The case of Malaysia. International journal for equity in health.
Crivelli, L. and Salari, P. (2014). The Inequity Of The Swiss Health Care System Financing From A Federal State Perspective. International Journal For Equity In Health.
Downloads
Published
Issue
Section
License
- Papers must be submitted on the understanding that they have not been published elsewhere (except in the form of an abstract or as part of a published lecture, review, or thesis) and are not currently under consideration by another journal published by any other publisher.
- It is also the authors responsibility to ensure that the articles emanating from a particular source are submitted with the necessary approval.
- The authors warrant that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required.
- The authors ensure that all the references carefully and they are accurate in the text as well as in the list of references (and vice versa).
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Attribution-NonCommercial 4.0 International that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author.
