Submission ID 118225
| Issue/Objective | The first point of contact in the healthcare system often determines the care pathway, influencing the type and cost of services utilized. In Nigeria, although primary health centers are designated as the primary point of care, most initial or sole contacts occur through informal pathways. In an environment with high out-of-pocket expenditure (OOPE), which can lead to catastrophic health costs, it is crucial to understand how the first point of contact affects OOPE. |
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| Methodology/Approach | Using data from a cohort of 9,274 households from the 2021 Nigeria National Living Standards Survey that incurred OOPE, we employed multiple linear regression models to assess the relationship between total OOPE (dependent variable) and the first point of contact with the healthcare system (independent variable). The point of contact was trichotomized into high-level formal providers, low-level formal providers, and informal providers. High-level formal providers have highly specialized training, lower-level formal providers are licensed with lower qualifications, and informal providers lack requisite training and licenses. The type of illness was identified as a potential confounder and adjusted for in our model. OOPEi=β0 + β1HighFormali +β2LowFormali + β3Informali + β4ChronicIllnessi + ϵi |
| Results | The majority of households (7,451; 80.3%) consulted formal providers as their first point of contact, 10.6% consulted informal providers and 9.1% consulted low-level formal providers. Multiple linear regression analysis showed that households consulting high-level formal providers had significantly higher OOPE compared to those consulting low-level formal providers and informal providers at P-value < 0.05. Specifically, high-level formal providers were associated with the highest OOPE, followed by informal providers, and then low-level formal providers, who had the lowest OOPE. These results remained significant after adjusting for the type of illness, indicating that the financial impact of the first point of contact varied by provider type. |
| Discussion/Conclusion | The first point of contact with healthcare providers significantly influences OOPE in Nigeria. High-level formal providers incur the highest costs, followed by informal providers, with low-level formal providers incurring the lowest costs. These findings highlight the importance of strengthening gatekeeping in Nigeria's healthcare system to ensure care is provided by qualified but more cost-effective healthcare professionals |
| Presenters and affiliations | Oluwafisayomi Patrick Center for Health Economics and Development Toluwani Oluwatola Genesis Analytics |
