Abstract

Out-of-pocket expenditure (OOPE) on healthcare has continued to be a prevalent health financing method in most low- and middle-income countries, especially in Sub-Saharan Africa, where fragile insurance systems and insufficient government funding still prevail. The current narrative review will explore effects of OOPE on vulnerable populations, specifically in Nigeria and other similar settings. It integrates evidence on conceptual foundation, patterns, determinants and consequences of OOPE, and how it influences healthcare access, utilization and outcomes. Evidence shows that high OOPE is a major cause of disastrous health spending and household poverty, particularly in low-income populations, rural populations, and the chronically ill. It also results in poor adherence to treatment, low use of preventive services and delayed care-seeking, thus exacerbating health outcomes. The review also illustrates a cyclic nature between OOPE, poverty, and ill health that strengthens socioeconomic inequalities. The identified policy responses, including the increased spending on the public health, the increase in insurance coverage, and the targeted social protection programmes, are deemed as the critical measures to address OOPE. All in all, OOPE reduction is crucial to improving financial protection, equitable access to healthcare, and making strides towards universal health coverage in resource-limited environments.

Keywords: Out-of-pocket expenditure, Catastrophic health expenditure, Healthcare financing, Vulnerable populations, Universal health coverage,

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