Contribution of household health care expenditure to poverty in Oyo State, South West Nigeria: A rural and urban comparison

Introduction: The financial burden of health care costs in Nigeria is borne almost entirely by the individuals and household members as health care financing is still mostly from out of pocket (OOP) payments. OOP payments can lead households into poverty. This study aimed to estimate the contribution of household health care expenditure to poverty in rural and urban communities in Oyo state, Nigeria. Method: This is a comparative cross-sectional study using a tested and adapted version of the Living Standard Survey questionnaire to collect data on 5,696 household members from 1,434 household representatives. Representatives were selected using a multistage sampling method. Information was collected from 714(49.8%) and 720(50.2%) households in the urban and rural Local Government Area (LGA), respectively. International poverty line of $1.25 per day was used. Poverty level was measured with and without household health expenditure. An exact McNemar’s test was used to determine the difference in the proportion of poor, gross and net payment for health care services. SPSS software was used for data analysis. Results: Health care was utilised by 1,006 (70.2%) of the 1,434 households studied. Of urban and rural households, 637(89.2%) and 369(51.3%) utilized health care services, respectively. Only 513(29.8%) were poor while 1519(88.2%) were poor after considering the cost of utilising health care. Increase in poverty of 66.2% occurred because of health care utilisation (p<0.001). Conclusion: Health care expenditure increased the proportion of household members living below poverty line. To protect against poverty free basic health care services is required in Nigeria. Keywords: Cost, Out of Pocket, Poverty, Expenditure