Payment Patterns in Nigeria’s Public Facilities: Unexpected Costs and Implications for Health-seeking Behaviour in Nigeria

In Nigeria’s health system, a better understanding is needed on the impact that unexpected costs have on health seeking behaviour. Of note, patients’ health-seeking choices between public vs. private facilities is influenced by their ex-ante perception of public vs. private facilities’ cost, quality, and accessibility. Lowered or abolished user fees at public facilities tend to increase utilization because patients believe the full cost of care is lowered. However, evidence points to care-related costs being passed off to the patient in other ways and at various points in a care episode. Since little is known about the impact that payment expectations and patterns have on health seeking behaviour, the ideal user fee payment structure and appropriate ways of financing it are also poorly understood. In this country case study, we explore patterns in user fees at public hospitals and its potential relationship to utilization, investigate the phenomena of unexpected antenatal and delivery costs and payment patterns specific to Lagos’ public hospitals, and examine the relationship between unexpected costs and patients’ attendance of public facilities in 11 local government areas within Lagos state