Determinants of Out-of-pocket Health Expenditure Among Older Adults: Evidence From the Nigeria Living Standards Survey 2018–19

The study examined the determinants of out-of-pocket health expenditure among older adults in Nigeria. The data came from the Nigeria Living Standards Survey 2018–19. We employed a two-part model involving logistic regression and a generalized linear model to identify factors associated with out-of-pocket health expenditures among older adults. Analyses were performed using STATA version 14.2 software. The findings indicated that 79.49% of older adults made out-of-pocket payments for health care. The mean monthly out-of-pocket health expenditure among older adults was 3,498.14 naira (US$9.72). Having health insurance significantly reduced the risk of incurring out-of-pocket health expenditure, while larger household sizes, primary education, tertiary education, and being from a poorer household significantly increased the risk of incurring out-of-pocket health expenditure among older adults. The study concludes that a high proportion of older adults incur out-of-pocket health expenditures. This implies that older adults are not protected from the financial hardship of out-of-pocket health expenditures by the Nigerian health care system. Policymakers should target the factors that increase the likelihood of incurring out-of-pocket health expenditures in the design of health financing policies aimed at reducing OOP health expenditures for older adults. The finding that health insurance reduces the likelihood of incurring out-of-pocket health expenditures indicates that it is important to design and implement a social health protection scheme for older adults.