Zandam et al (2019). Assessing disparities in demand and health care expenditures burden in Nigeria: A comparison between people with physical disability and counterparts with no disability

Background: People with disabilities often have a diverse range of health needs. In addition to needed treatment and rehabilitation for their specific impairment, they often have higher risks of developing secondary conditions (e.g. depression) and comorbidities such as high blood pressure compared to individuals without disabilities. Consequently, they require more healthcare with a resultant high healthcare expense, which places additional demands on their household budgets. Given that individuals with disabilities are also more likely to be living in poverty, these expenditures pose a significant burden, impoverishment, and affect their health seeking behaviour. This study estimates healthcare expenditures and the burden associated with a physical disability in comparison with people without disability in a Northwestern, Nigeria. Methods: A prospective cross-sectional study was conducted on 426 people with physical disabilities and sex and age-matched counterparts without disability, recruited using a multistage sampling method. The study collected household and individual information using a structured questionnaire. Data were analyzed using independent samples T-test and OLS log-normal model to examine differences in health-related expenditures, total out-of-pocket spending (OOP) and burden across disability status. The differences were adjusted for factors including demographics and socioeconomic factors, health and access to healthcare. Findings: Between the study periods, people with physical disabilities consistently had higher total health expenditures, OOP and burden compared to their counterparts without disabilities. In the post-harvest period, the median expenditures were estimated at NN9900 ($50) for people with physical disabilities and N5400 ($23) for those without disabilities. Multivariate analyses show that people with physical disabilities were consistently found to have higher expenditures, OOP and burden during the two periods. The expenditures, OOP and burden increased over time and did not change even after other factors were adjusted. Conclusions: People with physical disabilities were consistently found to have significantly higher healthrelated expenditures and at the risk of catastrophic health expenditure compared to their counterparts without disability. Providing healthcare coverage can ease financial burden and improve healthcare seeking