Effect of COVID-19 on Catastrophic Medical Spending and Forgone Care in Nigeria
Abstract
:1. Introduction
2. Methods and Data
2.1. Framework
2.2. Descriptive Statistical Analysis Using Mean and Percentage Distribution Techniques
2.3. Standard Approaches to the Computation of CHE and Forgone Medical Care and the Measurement of the Effect of COVID-19
2.3.1. CHE Incidence
2.3.2. Effect of COVID-19 Legal Restrictions or COVID-19 Lockdown Policy on CHE
2.3.3. Forgone Medical Care Incidence
2.3.4. Effect of COVID-19 Legal Restrictions on Forgone Medical Care Incidence
2.4. Datasets
3. Findings
3.1. Summary Statistics
3.2. Prevalence of CHE and Forgone Medical Care Incidences
3.3. Effect of COVID-19 Legal Restrictions on CHE and Forgone Medical Care
4. Summary of Findings and Policy Implications
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
1 | Note that the 51% represents the average across the samples in both wave 1 and wave 2 of the panel sample. In wave 1, when the lockdown measure was fully in effect, the estimate of households affected was higher at 59%, compared to 41% in wave 2, when the lockdown measure was partially lifted. |
2 | The CHE variable was calculated from the pre-COVID-19 survey. However, variables necessary for calculating CHE (out-of-pocket payments and income/consumption expenditure) were not included in the COVID-19 survey. Hence, we were unable to calculate the CHE variable for the COVID-19 period. Nevertheless, the households in the pre-COVID-19 survey are the same households studied in the COVID-19 period, which allows us to merge and append the datasets to form a panel. To enable a cross-sectional examination of the effect of COVID-19 legal restriction on CHE, we merged the pre-COVID-19 and the COVID-19 variables. For the panel analyses these datasets were appended across the first two waves of the COVID-19 survey periods. |
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Variable | Obs | Mean | Std. Dev. | Min | Max |
---|---|---|---|---|---|
CHE | 3770 | 0.4095 | 0.4918 | 0 | 1 |
Forgone care due to financial reasons | 1502 | 0.1019 | 0.3026 | 0 | 1 |
Forgone care due to any reason | 1502 | 0.1272 | 0.3333 | 0 | 1 |
COVID-19 legal restrictions | 3770 | 0.5088 | 0.4990 | 0 | 1 |
Zone (northern) | 3770 | 0.4910 | 0.4990 | 0 | 1 |
Sector (rural) | 3770 | 0.6095 | 0.4879 | 0 | 1 |
Gender (female) | 3770 | 0.4992 | 0.5038 | 0 | 1 |
Economic Status | |||||
Second quintile | 3770 | 0.1955 | 0.3966 | 0 | 1 |
Third | 3770 | 0.1981 | 0.3986 | 0 | 1 |
Fourth | 3770 | 0.2175 | 0.4126 | 0 | 1 |
Richest | 3770 | 0.2273 | 0.4192 | 0 | 1 |
Education Levels | |||||
Nursery and primary | 3770 | 0.4045 | 0.4909 | 0 | 1 |
Secondary | 3770 | 0.1070 | 0.3104 | 0 | 1 |
Post-secondary | 3770 | 0.1008 | 0.3011 | 0 | 1 |
Formal wage employment | 3770 | 0.0780 | 0.2682 | 0 | 1 |
Insurance (=1) | 3770 | 0.0095 | 0.0973 | 0 | 1 |
Elderly (=1) | 3770 | 0.1613 | 0.3678 | 0 | 1 |
Threshold | 10% Share of Total Expenditure, Col. 1 | 25% Share of Total Expenditure, Col. 2 | 40% Share of Total Non-Food Expenditure, Col. 3 | |||
---|---|---|---|---|---|---|
Variables | Proportion | Std Error | Proportion | Std Error | Proportion | Std Error |
National | 0.4118 *** | 0.0111 | 0.1672 *** | 0.0084 | 0.3144 *** | 0.0105 |
Rural | 0.4519 *** | 0.0144 | 0.1908 *** | 0.0114 | 0.3657 *** | 0.0154 |
Urban | 0.3483 ** | 0.0173 | 0.1298 *** | 0.0122 | 0.2344 *** | 0.0139 |
Northern | 0.4784 ** | 0.0162 | 0.2091 *** | 0.0132 | 0.3759 *** | 0.0157 |
Southern | 0.3489 *** | 0.0150 | 0.1276 *** | 0.0105 | 0.2572 *** | 0.0138 |
Forgone Care | Wave 1 | Wave 2 | Average of Waves 1 and 2 | Obs |
% of all sampled households. Number of households who reported forgone care divided by all the households. | 6.0 *** (0.0054) | 3.8 *** (0.0043) | 5.0 *** (0.0036) | 3770 |
% of households that need care. Number of households who reported forgone care divided by only the households that need care. | 13.0 *** (0.0112) | 12.4 ** (0.0134) | 12.7 *** (0.0086) | 1502 |
Reasons for forgoing care | Wave 1 | Wave 2 | Average of Waves 1 and 2 | |
Due to financial reasons, % of all sampled households | 4.9 *** (0.0049) | 2.9 *** (0.0038) | 4.0 *** (0.0032) | 3770 |
Due to financial reasons, % of households that need care | 11.0 *** (0.0103) | 9.5 *** (0.0120) | 10.2 *** (0.0078) | 1502 |
Due to COVID-19 reasons, % of all sampled households | 0.9 *** (0.0022) | 0.1 *** (0.0008) | 1.0 *** (0.0012) | 3770 |
Due to COVID-19 reasons, % of households that need care | 2.0 *** (0.0047) | 0.3 *** (0.0024) | 1.2 *** (0.0030) | 1502 |
Due to supply reasons, % of all sampled households | 0.9 *** (0.0022) | 0.3 *** (0.0012) | 1.0 *** (0.0013) | 3770 |
Due to supply reasons, % of households that need care | 2.0 *** (0.0047) | 1.0 *** (0.0037) | 2.0 *** (0.0032) | 1502 |
Due to other reasons, % of all sampled households | n/a | 0.6 *** (0.0017) | 0.6 *** (0.0017) | 3770 |
Due to other reasons, % of households that need care | n/a | 1.7 *** (0.0052) | 1.7 *** (0.0052) | 1502 |
Mean Medical Expenditures | Mean Total Expenditures | Mean Food Expenditures | Mean Non-Food Expenditures | Mean Non-Food Less Medical Exp. | |
---|---|---|---|---|---|
National | 2522.6 | 19,295.2 | 11,189.3 | 8105.9 | 5583.4 |
Regional | |||||
Urban | 2560.2 | 24,512.3 | 13,094.5 | 11,417.9 | 8857.7 |
Rural | 2498.5 | 15,953.3 | 9968.9 | 5984.4 | 3485.9 |
Geopolitical | |||||
Southern | 2606.4 | 23,151.9 | 13,199.1 | 9952.8 | 7346.5 |
Northern | 2435.7 | 15,296.8 | 9105.7 | 6191.2 | 3755.5 |
Quintiles | |||||
Quintile 1 | 1357.6 | 5980.4 | 3879.8 | 2100.7 | 743.1 |
Quintile 2 | 1776.9 | 9956.3 | 6379.8 | 3576.6 | 1799.6 |
Quintile 3 | 2371.0 | 14,115.1 | 8743.5 | 5371.6 | 3000.5 |
Quintile 4 | 2694.3 | 20,389.4 | 12,036.5 | 8352.9 | 5658.5 |
Quintile 5 | 3959.3 | 40,256.4 | 21,840.7 | 18,415.7 | 14,456.3 |
% Medical Expenditures | % Food Expenditures | % Non-Food Expenditures | % Non-Food Less Medical Expenditures | |
---|---|---|---|---|
National | 15.9 | 60.7 | 39.3 | 23.4 |
Regional | ||||
Urban | 12.4 | 55.8 | 44.2 | 31.8 |
Rural | 18.1 | 63.9 | 36.1 | 17.9 |
Geopolitical | ||||
Southern | 12.5 | 59.6 | 40.4 | 27.9 |
Northern | 19.4 | 61.9 | 38.1 | 18.7 |
Quintiles | ||||
Quintile 1 | 23.3 | 64.5 | 35.2 | 11.8 |
Quintile 2 | 17.8 | 64.1 | 35.9 | 18.1 |
Quintile 3 | 16.6 | 62.0 | 37.9 | 21.4 |
Quintile 4 | 13.2 | 59.1 | 40.9 | 27.7 |
Quintile 5 | 10.9 | 55.3 | 44.7 | 33.8 |
Logit Models | ||||
---|---|---|---|---|
Catastrophic Medical Expenditure (=1) | Forgone Medical Care (=1) | |||
Variables | Coefficients, Col. 1 | Marginal Effects, Col. 2 | Coefficients, Col. 3 | Marginal Effects, Col. 4 |
COVID-19 legal restrictions | −0.3293 ** (0.1412) | −0.0759 ** (0.0323) | 0.5158 *** (0.0021) | 0.0460 *** (0.0002) |
Gender (1 = female and 0 = otherwise) | 0.0721 (0.1366) | 0.0166 (0.0315) | −0.2903 *** (0.0019) | −0.0259 *** (0.0002) |
Sector (1 = rural and 0 = otherwise) | −0.0568 (0.1529) | −0.0131 (0.0352) | −0.3483 *** (0.0023) | −0.0310 *** (0.0002) |
Zone (1 = northern and 0 = otherwise) | 0.2205 (0.1537) | 0.0508 (0.0353) | 0.1148 *** (0.0023) | 0.0102 *** (0.0002) |
Economic status | ||||
Second quintile | −0.4578 ** (0.2217) | −0.1112 ** (0.0535) | −0.3836 *** (0.0025) | −0.0484 *** (0.0003) |
Third | −0.6842 *** (0.2303) | −0.1652 *** (0.0548) | −0.8619 *** (0.0031) | −0.0934 *** (0.0003) |
Fourth | −0.7516 *** (0.2341) | −0.1809 *** (0.0554) | −1.2291 *** (0.0034) | −0.1183 *** (0.0003) |
Richest | −1.0118 *** (0.2446) | −0.2389 *** (0.0561) | −1.6511 *** (0.0042) | −0.1389 *** (0.0003) |
Education levels | ||||
Nursery and primary | −0.1828 (0.1552) | −0.0420 (0.0357) | −0.1160 *** (0.0023) | −0.0105 *** (0.0002) |
Secondary | −0.0097 (0.2549) | −0.0023 (0.0593) | −1.2032 *** (0.0045) | −0.0737 *** (0.0002) |
Post-secondary | 0.2878 (0.2525) | 0.0677 (0.0595) | 0.6060 *** (0.0028) | 0.0702 *** (0.0003) |
Employment (1 = employed and 0 = otherwise) | −1.0791 *** (0.3112) | −0.2487 *** (0.0709) | −0.3812 *** (0.0059) | −0.0339 *** (0.0005) |
Insurance (1 = insured and 0 = otherwise) | −0.2199 (0.6532) | −0.0507 (0.1505) | 0.0000 (0.0000) | 0.0000 (0.0000) |
Elderly (1 = elder and 0 = otherwise) | 0.0994 (0.0994) | 0.0229 (0.0229) | −0.4086 (0.0035) | −0.0364 *** (0.0003) |
Constant | 0.4152 (0.2815) | −1.3049 (0.0039) | ||
Wald chi2 (15) | 54.48 (0.0000) | 761,025.28 (0.0000) | ||
Pseudo R2 | 0.0423 | 0.0897 | ||
Number of observations | 1950 | 1950 | 903 | 903 |
Logit Models | ||||
---|---|---|---|---|
Variables | Catastrophic Medical Expenditure | Forgone Medical Care | ||
Coefficients, Col. 1 | Marginal Effects, Col. 2 | Coefficients, Col. 3 | Marginal Effects, Col. 4 | |
COVID-19 legal restrictions | 0.0417 (0.1489) | 0.0096 (0.0342) | 0.7939 *** (0.0026) | 0.0669 *** (0.0002) |
Gender (1 = female and 0 = otherwise) | 0.0472 (0.1428) | 0.0108 (0.0328) | −0.2889 *** (0.0023) | −0.0243 *** (0.0002) |
Sector (1 = rural and 0 = otherwise) | −0.0116 (0.1569) | −0.0027 (0.0360) | −0.8534 *** (0.0027) | −0.0719 *** (0.0002) |
Zone (1 = northern and 0 = otherwise) | 0.3104 * (0.1629) | 0.0712 * (0.0370) | −0.5533 *** (0.0029) | −0.0466 *** (0.0002) |
Economic status | ||||
Second quintile | −0.4445 * (0.2347) | −0.1084 * (0.0568) | −0.0264 *** (0.0032) | −0.0028 *** (0.0003) |
Third | −0.7839 *** (0.2411) | −0.1891 *** (0.0571) | −0.2384 *** (0.0036) | −0.0233 *** (0.0004) |
Fourth | −0.7064 *** (0.2427) | −0.1711 *** (0.0579) | −0.8013 *** (0.0040) | −0.0649 *** (0.0003) |
Richest | −1.1441 *** (0.2544) | −0.2680 *** (0.0575) | −1.1176 *** (0.0049) | −0.0814 *** (0.0003) |
Education levels | ||||
Nursery and primary | −0.1188 (0.1612) | −0.0272 (0.0369) | 0.3287 *** (0.0025) | 0.0303 *** (0.0002) |
Secondary | −0.0912 (0.2558) | −0.0209 (0.0585) | −1.2033 *** (0.0065) | −0.0636 *** (0.0636) |
Post-secondary | −0.0118 (0.2704) | −0.0027 (0.0624) | −0.4346 *** (0.0048) | −0.0303 *** (0.0003) |
Employment (1 = employed and 0 = otherwise) | −0.8077 ** (0.3253) | −0.1853 ** (0.0742) | −0.1293 *** (0.0079) | −0.0109 *** (0.0007) |
Insurance (1 = insured and 0 = otherwise) | −0.1746 (0.6316) | −0.0400 (0.1449) | 2.0278 *** (0.0080) | 0.1709 *** (0.0007) |
Elderly (1 = elder and 0 = otherwise) | 0.4626 ** (0.1843) | 0.1061** (0.1061) | −0.7090 *** (0.0039) | −0.0597 *** (0.0003) |
Constant | 0.0739 (0.2919) | −1.1421 *** (0.0046) | ||
Wald chi2 (15) | 52.00 (0.0000) | 575,288.62 (0.0000) | ||
Pseudo R2 | 0.0434 | 0.0931 | ||
Number of observations | 1820 | 1820 | 599 | 599 |
Logit Models | |||
---|---|---|---|
Catastrophic Medical Expenditure | Forgone Medical Care Due to Financial Reasons | Forgone Medical Care Due to Any Reason | |
Variables | Marginal Effects, Col. 1 | Marginal Effects, Col. 2 | Marginal Effects, Col. 3 |
COVID-19 legal restrictions | −0.0161 *** (0.0001) | 0.0313 *** (0.0001) | 0.0205 *** (0.0001) |
Gender (1 = female and 0 = otherwise) | 0.0007 *** (0.0001) | −0.0135 *** (0.0001) | −0.0154 *** (0.0001) |
Sector (1 = rural and 0 = otherwise) | 0.0288 *** (0.0001) | 0.0287 *** (0.0001) | 0.0296 *** (0.0002) |
Zone (1 = northern and 0 = otherwise) | 0.0454 *** (0.0001) | 0.0092 *** (0.0002) | 0.0246 *** (0.0002) |
Economic status | |||
Second quintile | −0.1292 *** (0.0004) | 0.0376 *** (0.0002) | 0.0424 *** (0.0002) |
Third | −0.3306 *** (0.0003) | −0.0077 *** (0.0002) | −0.0087 *** (0.0002) |
Fourth | −0.3799 *** (0.0003) | −0.0389 *** (0.0002) | −0.0335 *** (0.0002) |
Richest | −0.4434 *** (0.0002) | −0.0513 *** (0.0002) | −0.0396 *** (0.0002) |
Education levels | |||
Nursery and primary | −0.0105 *** (0.0001) | 0.0068 *** (0.0001) | 0.0085 *** (0.0002) |
Secondary | −0.0199 *** (0.0002) | −0.0187 *** (0.0002) | −0.0252 *** (0.0002) |
Post-secondary | 0.0495 *** (0.0002) | 0.0483 *** (0.0003) | 0.0417 *** (0.0003) |
Employment (1 = employed and 0 = otherwise) | −0.0988 *** (0.0002) | −0.0241 *** (0.0003) | −0.0404 *** (0.0003) |
Insurance (1 = insured and 0 = otherwise) | −0.1229 *** (0.0005) | −0.0218 *** (0.0008) | −0.0463 *** (0.0009) |
Elderly (1 = elder and 0 = otherwise) | 0.0406 *** (0.0002) | 0.0286 *** (0.0002) | 0.0457 *** (0.0002) |
Number of observations | 3770 | 1502 | 1502 |
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Edeh, H.C.; Nnamani, A.U.; Ozor, J.O. Effect of COVID-19 on Catastrophic Medical Spending and Forgone Care in Nigeria. Economies 2025, 13, 116. https://doi.org/10.3390/economies13050116
Edeh HC, Nnamani AU, Ozor JO. Effect of COVID-19 on Catastrophic Medical Spending and Forgone Care in Nigeria. Economies. 2025; 13(5):116. https://doi.org/10.3390/economies13050116
Chicago/Turabian StyleEdeh, Henry Chukwuemeka, Alexander Uchenna Nnamani, and Jane Oluchukwu Ozor. 2025. "Effect of COVID-19 on Catastrophic Medical Spending and Forgone Care in Nigeria" Economies 13, no. 5: 116. https://doi.org/10.3390/economies13050116
APA StyleEdeh, H. C., Nnamani, A. U., & Ozor, J. O. (2025). Effect of COVID-19 on Catastrophic Medical Spending and Forgone Care in Nigeria. Economies, 13(5), 116. https://doi.org/10.3390/economies13050116