GENDER ANALYSIS OF HEALTHCARE EXPENDITURES IN RURAL NIGERIA

Abstract

Heath inequities have significant social and economic costs to both individuals and societies. These inequities are largely due to gender based differences which influence health conditions, access to and utilization of health services. However, information on gender dissimilarities in health seeking behaviour, especially in rural Nigeria, is limited. Therefore, gender pattern in healthcare expenditure in rural Nigeria was investigated. Secondary data from 2009 Harmonised National Living Standard Survey (HNLSS) were used for the study. Information on 24,941 rural households [Agricultural Households (AH) and Non-agricultural households (NAH)] in Nigeria was used. Data used were socio-economic and demographic characteristics (sex, age, marital status, household size, educational level, farm size and occupation), health condition, water sources and sanitation facilities, occupation, education and access to training. Other variables used in the study were household expenditures, involvement in agricultural activities, access to credit and savings status. Four major health decision variables: Health Status (HS), Medical Consultation (MC), Treatment Costs (TC) and Actual Medical Expenditure (AME) representing the four stages of health seeking behaviour were used. Rural households were grouped into youths [Female Youths (FY) and Male Youths (MY)] and adults [Female Adults (FA) and Male Adults (MA)] for gender analysis. Data were analysed using descriptive statistics, inequality measures, Engel curve and Generalized Structural Equation Model (GSEM) at α0.05. Mean monthly expenditure on health per person was higher for MA (₦7,256.4±629.0) than FA (₦5,115.4±503.9). The FY spent more (₦4,433.6±668.1) on health care than MY (₦3,857.9±671.3). For AH, MY (76.7%) and MA (68.8%) contributed more to health expenses than their counterparts (23.3% and 31.2% for FY and FA, respectively) while FY (60.3%) and MA’s (57.3%) contributions were higher than that of MY (39.7%) and FA (42.7%) for NAH. Among AH, FA accounted for the largest proportion (61.2%) of households’ total health expenditure while FY (4.6%) had the least. The corresponding figures for NAH are 46.1% and 28.7% for MA and MY, respectively. Men were 33.4% less likely to report being sick than women and the degree of inequality in AME was almost equal for both male (0.59) and female (0.55). Income elasticity of AME was 0.234 which implies that a 1% change in income will lead to less than 1% change in medical expenditure of an individual. Gender analysis was done at HS and MC stages as sex and age disparities were only significant for these stages. Per capita expenditure (β=0.774), health decision (β=1.226) and household size (β=0.350) increased HS, while sex (β=-0.334), marital status [monogamous (β=-0.725), polygamous (β=-5.807) or once married (β=-0.594)], education (β=-0.012) and personal care (β=-0.008) reduced HS. Health decision (β=0.336), household size (β=0.484), training (β=0.850) and per capita expenditure (β=0.334) increased MC while sex (β=-0.309) and dependency ratio (β=-0.152) decreased MC. Although rural women in Nigeria have a higher likelihood of being sick, which creates the need for higher health seeking behaviour, they do not spend as much on health care services as men. Investment in health increased with age irrespective of the sex of the household members.

Keywords: Health, Gender, Triple hurdle model, Generalized structural equation model, Rural Nigeria. Word count: 495