Volume 14, Issue 2 (Spring- In Press 2026)
Iran J Health Sci 2026, 14(2): 0-0 |
Back to browse issues page
Ethics code: NHREC/01/01/2022-017
Clinical trials code: NA
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Yaqoob A M, Salisu A A, Obumneke E. Income-related inequalities and inequities in access to inpatient healthcare: A Decomposition analysis among rural households in Nigeria. Iran J Health Sci 2026; 14 (2)
URL: http://jhs.mazums.ac.ir/article-1-1115-en.html
URL: http://jhs.mazums.ac.ir/article-1-1115-en.html
Department of Economics and Development Studies, Faculty of Management and Social Sciences, Prime University Abuja, FCT, Nigeria. , yaqoobmajeed042@gmail.com
Abstract: (35 Views)
Background and purpose: Healthcare inequality remains a major challenge in Nigeria, particularly in rural areas where access to essential inpatient services is uneven and reliance on informal providers is common. Existing studies have largely focused on inequalities in specific services, with limited evidence on disparities across formal healthcare settings. This study examines income-related inequalities and horizontal inequities in access to inpatient healthcare in rural Nigeria.
Materials and methods: Cross-sectional data from 624 households collected under the Human Capital Research Project (AERC) were used. The data set contained detailed information on household demographics and socioeconomic characteristics as well as information on inpatient healthcare utilization. Income-related inequality in healthcare use was measured using the Concentration Index (CI), while horizontal inequity was assessed using need-standardized Concentration Indices (HI) derived through indirect standardization. A decomposition analysis of the CI was conducted to quantify the relative contributions of socioeconomic, demographic, and health-related factors to observed inequalities.
Results: Access to inpatient care was 81.4%, 49.9%, and 18.4% for public primary, secondary, and tertiary facilities, respectively, and 32.7% for private facilities. Access to public primary and secondary care decreased with wealth, whereas access to tertiary and private care increased. Significant pro-poor inequalities and inequities were observed for public primary (CI = −0.1054, 95% CI: -0.1818, -0.0290; HI = −0.0374, p < 0.05) and secondary care (CI = −0.1063, 95% CI: -0.2047, -0.0790; HI = −0.0377, p < 0.05), while significant pro-rich inequalities were found for tertiary (CI = 0.2382, 95% CI: 0.1645, 0.3119; HI = 0.3660, p < 0.01) and private care (CI = 0.1502, 95% CI: 0.0585, 0.2419; HI = 0.2180, p < 0.01). Economic status and region of residence contributed most to observed inequalities.
Conclusion: Income-related inequalities in access to inpatient healthcare are driven mainly by economic status and region of residence highlighting that policies aimed at reducing financial barriers (e.g., subsidized healthcare, insurance expansion) and region-specific interventions (e.g., improving rural healthcare infrastructure) are likely to be most effective in addressing these disparities.
Materials and methods: Cross-sectional data from 624 households collected under the Human Capital Research Project (AERC) were used. The data set contained detailed information on household demographics and socioeconomic characteristics as well as information on inpatient healthcare utilization. Income-related inequality in healthcare use was measured using the Concentration Index (CI), while horizontal inequity was assessed using need-standardized Concentration Indices (HI) derived through indirect standardization. A decomposition analysis of the CI was conducted to quantify the relative contributions of socioeconomic, demographic, and health-related factors to observed inequalities.
Results: Access to inpatient care was 81.4%, 49.9%, and 18.4% for public primary, secondary, and tertiary facilities, respectively, and 32.7% for private facilities. Access to public primary and secondary care decreased with wealth, whereas access to tertiary and private care increased. Significant pro-poor inequalities and inequities were observed for public primary (CI = −0.1054, 95% CI: -0.1818, -0.0290; HI = −0.0374, p < 0.05) and secondary care (CI = −0.1063, 95% CI: -0.2047, -0.0790; HI = −0.0377, p < 0.05), while significant pro-rich inequalities were found for tertiary (CI = 0.2382, 95% CI: 0.1645, 0.3119; HI = 0.3660, p < 0.01) and private care (CI = 0.1502, 95% CI: 0.0585, 0.2419; HI = 0.2180, p < 0.01). Economic status and region of residence contributed most to observed inequalities.
Conclusion: Income-related inequalities in access to inpatient healthcare are driven mainly by economic status and region of residence highlighting that policies aimed at reducing financial barriers (e.g., subsidized healthcare, insurance expansion) and region-specific interventions (e.g., improving rural healthcare infrastructure) are likely to be most effective in addressing these disparities.
Keywords: Health Status Disparities, Hospitalization, Public Sector, Health Services Accessibility and Concentration Index (CI)
Type of Study: Original Article |
Subject:
Health Economics
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Contact Information
