1.1 Background to the Study
Many international institutions, including the World Bank and the World Health Organization (WHO), have recommended that countries should adopt universal health care coverage, believing that adequate health care is a basic human right. Nigeria is one of the countries that implemented this recommendation. For example, several initiatives and health schemes have been introduced by successive Nigerian governments specifically focusing on the middle class. These include the Family Economic Advancement Programme (FEAP), Family Support Programme (FSP) and National Health Insurance Scheme (NHIS). These schemes seek to ensure that every Nigerian has access to good and affordable health care services and that medical cost are distributed equitably among different income groups. However, the success of these initiatives and schemes has not been adequately felt by the poor (Osinubi, 2003). Specifically, access to affordable social services and health care services is being determined by the household income of the family. While the rich in urban areas of the country have access to quality health care services, the poor in both rural and urban areas are largely deprived access to quality health care services.
Healthcare financing in Nigeria is dominated by private out-of-pocket payment that is not affordable to the poor. This has greatly reduced access to quality health care for the predominantly poor households. Deaton (2003) posit that every individual has a need or a potential need for health care in the form of health promotion, prevention, cure or rehabilitation. This need is not always translated into a demand for health care particularly in developing countries for various reasons.
Several scholars have given reasons why there is inequality in access to quality healthcare among the various households. Ogunbekun, Ogunbekun, and Orobaton (1999) identify price of health care which may not be affordable by the individuals (Affordability). Ichoku and Leibbrandt (2003) argued that the Individuals may not have ready access to the health facility at a time or place that is convenient (Geographical accessibility). Green (2002) notes that the service required may not be available to the individual (Availability). Green further pointed that religious and cultural believes and practices may hinder the use of the health facilities (Acceptability). While Lambo (2003) notes that cost of time off from work and costs of waiting the demand for health care hinders accessibility to quality healthcare in Nigeria.
Focusing on household income as predictor of the demand for healthcare, in 1988, the World Bank conducted an extensive study on household demand for outpatient services in Ogun State. The empirical model assumed that choice of health care is a function of the following; price of the care, quality of the care, sex and education of the patients, wealth of the household, income of the household, urban residence, symptoms of the illness and seriousness of the illness (World Bank, 1988). In 2000 the World Health Organization ranked the performance of Nigeria’s health system 187th of 191 countries. The challenges facing Nigeria’s health system often fall into at least one of three categories: resources, access, and structure.
Due to the reduced access to health care, households often resort to leave the illness untreated or resort to the use of low quality care or self-medication. In the long-run, this will further impoverish the households (OECD/WHO, 2003). When the households decide to make out-of-pocket payments for medical bills at the point of utilization of health services this is often catastrophic in nature, especially for the poor. This is because health care payment is not expected to exceed a certain threshold of household income. In most circumstances, poor households face actual medical bills that exceed their earnings.
In this regard, this work explores the variables of household income, religious belief and educational background as the affect the demand for health care in Nigeria.
1.2 Statement of the Problem
Demand for healthcare is not only driven by the financial status of the citizen. Other factors may also affect healthcare demand in Nigeria. Among these proposed factors is religious belief, particularly of some Christians who believe in diving health/healing as well as those who resort to the use of traditional herbs. Also, the educational background of the people could also affect their healthcare demand. For instance, most of those who benefitted from the National Health Insurance Scheme have secondary school education with many of them possessing first degree.
However, the deregulation of health care financing and supply in Nigeria has shifted the healthcare system towards competitive market ideals. Unfortunately, few studies have examined how income, religious belief and educational background affect health care demand in the country. The study therefore seeks to find out how these variables influence the demand for healthcare in Nigeria.
1.3 Objectives of the Study
The general aim of this research is to examine how the variables of household income, religious belief and educational background affect the demand for healthcare in Nigeria using Ijebu-Ode as case study. To achieve this aim, the following objectives were set:
- To analyse the correlation between religious background of the family and demand for health care;
- To examine the relationship between economic status of the family and demand for health care;
- To find out the correlation between educational status of the family and demand for health care; and
1.4 Research Questions
- What correlation exists between religious background of the family and demand for health care?
- To what extent does economic status of the family affect demand for health care?
- Does the educational status of the family affect demand for health care?
1.5 Research Hypotheses
Ho1 There is no statistically significant difference between religious background of the family and demand for health care
Ho2 There is no statistically significant difference between economic status of the family and demand for health care
Ho3 There is no statistically significant difference between educational status of the family and demand for health care
1.6 Significance of the Study
This will aid our knowledge about economics of health education and how household income, religious belief and educational background influence the demand for health care in Nigeria.
It will also show why there is need for the government and the providers of health care managers to develop effective communication on educating low and middle income households about inexpensive national healthcare schemes.
This study will bring about understanding with regard to what problems households encounter in accessing health care especially in Ijebu metropolis. This will then allow the development of improved strategies of help or intervention either by the government or the individuals.
Lastly, it will serve as a contribution to knowledge in the subject area. In this regard, it will be useful for other researchers who might want to carry out research in related areas.
1.7 Scope of the Study
The aim of this study is to characterise the structure of inequality among households and its effect on demand for healthcare services in Nigeria.
This research therefore examines the influence of household income, religious belief and educational background on the demand for health care in Ijebu-Ode. This research work covers all households in Ijebu-Ode, an area of Ogun State. However, forty households will be used as case study.
1.8 Limitation of the Study
Apart from time frame and shortage of finance, the major limitation to this research is the inability of the researcher to cover the whole public households in Nigeria metropolis as the title suggest.
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