Sources of healthcare financing among surgical patients in a rural Niger Delta practice in Nigeria.

INTRODUCTION The environmental degradation following crude oil exploration in the Niger Delta has resulted in poverty for local rural dwellers. For those who are ill, if herbal treatments and/or self-medication with orthodox drugs are unsuccessful, the only alternative is expensive medical treatment in clinics. Surgical patients in a rural clinic may have to stay beyond than the normal 7 days if they are unable to pay their hospital bill; because this limits bed availability, there is an impacts on the hospital's economic management. This study aimed to determine the pattern of hospital bill payment among rural surgical patients in a rural Nigerian community, including the sources of finance for bill payment, in order to determine ways to resolve this issue. METHOD This cross-sectional study was conducted in a rural community in the Niger Delta area (Bethesda Clinic Ngo) over 5 years (2005-2009). RESULTS In the 5 year study period, 3712 patients were seen, of which 229 were surgical patients who consented to the study. Their ages ranged from 4 to 97 years (mean 45.6 ± 13.5 years) and most were fish farmers (79.91%), secondary-school leavers (56.33%) and of the Christian religion (86.03%). The association of these characteristics with a greater than 7 day hospital stay was statistically significant (p < 0.05). The most prevalent surgical procedure was herniorrhaphy but the longest staying patients were those who had an ectopic pregnancy (23.32 ± 7.52 days), cesarean section (19.51 ± 6.73 days), appendectomy (18.46 ± 6.82 days) and exploratory laparotomy (17.33 ± 8.32 days). The hospital bill ranged from US$33.3 to $500, with a mean of $105.7 ± 0.043. Their sources of finance for the hospital bill were multiple but mainly personal savings (71.18%). Few (3.06%) had knowledge of the National Health Insurance Scheme, but when informed about it 84.28% were willing to enroll. CONCLUSION The sources of finance for payment of hospital bills were multiple but the most common were personal savings and family members.