Two billion people face severe hardship due to out-of-pocket health spending

The World Health Organisation and the World Bank say about two billion people across the world face severe financial hardship when paying out-of-pocket for health services.

According to the World Bank metadata glossary, out-of-pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the enhancement of the health status of individuals.

The UN agencies said out-of-pocket health spending can also cause individuals to forgo essential care and force families to choose between paying for a visit to the doctor, buying food, and sending their children to school.

The 2023 Universal Health Coverage report jointly released by the agencies said such trade-offs can spell the difference between the early treatment of a preventable disease and, at a later stage, suffering severe illness or even death.

“Addressing this problem requires progressive health financing policies that exempt those with limited ability to pay for health services. Over the past two decades, less than a third of countries have improved health service coverage and reduced catastrophic out-of-pocket health spending,” the report stated.

The agencies defined catastrophic out-of-pocket health spending as exceeding 10% of a household budget, stating that over one billion people, about 14% of the global population, experienced such large out-of-pocket spending relative to their budgets.

“But even small expenditures in absolute terms can be devastating for low-income families. Approximately 1.3 billion individuals were pushed or further pushed into poverty by such payments, including 300 million people who were already living in extreme poverty,” it added.

Meanwhile, medical practitioners under the aegis of the HealthCare Providers Association of Nigeria said successful and transparent implementation of the NHIA Act is crucial for the attainment of UHC and can reduce out-of-pocket payments for healthcare.

They noted that the NHIA Act would make health insurance better in Nigeria, stressing that for Nigerians to enjoy the new act, the government would have to show the political will to implement the new act fully.

The Chairman of HCPAN, Lagos State chapter, Biola Paul-Ozieh, said the government must recognise that healthcare providers are key to the achievement of UHC in Nigeria and must be carried along at all times.

She regretted that the NHIA had been poorly funded over the years, saying that successful implementation of the Act requires a collaborative effort from all stakeholders, including the general public.

Meanwhile, the Kaduna State Government said it is working to reduce out-of-pocket expenditure on health services by 50 per cent, with a view to achieving Universal Health Coverage.

Director, Health Planning, Research and Statistics in the state Ministry of Health, Dr. Joseph Sunday, stated this at a two-day meeting on healthcare financing in Abuja.

He said out-of-pocket constitutes 84 per cent of the total expenditure on health, stressing the need for sustainable and innovative healthcare financing in the state.

Sunday added that the Health Financing Policy and Strategy, developed with support from Save the Children International, was designed to expand funding sources for the health sector in the state.

He said, “Part of the objective, therefore, is to increase government expenditure on health by five per cent and improve the coverage of residents on health risk protection mechanisms by 50 per cent.

“The policy also hopes to reduce the 84 percent out-of-pocket expenditure on health by 50 per cent and improve health expenditure on primary healthcare by 20 per cent.

“It is also designed to improve the coverage of vulnerable populations by 20 per cent under the health insurance scheme of the Kaduna State Contributory Health Management Authority (KADCHMA).

“This will strengthen healthcare financing systems to ensure accountability, transparency, and sustainability at the state and local government levels.”


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