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Impact of Healthcare Costs on Healthcare-Seeking Behaviour among Low-Income Households in Nigeria

Abstract

Healthcare costs are an important determinant of access to healthcare, particularly among low-income households that may have limited financial resources and are more vulnerable to the economic consequences of illness. Healthcare costs include direct medical expenses such as consultation fees, medicines, laboratory investigations, diagnostic procedures, hospital charges, and other treatment-related payments, as well as direct non-medical expenses such as transportation and indirect costs associated with time away from work or household activities. Healthcare-seeking behaviour refers to the actions and decisions individuals and households take when experiencing illness or requiring preventive healthcare, including whether to seek professional care, where to seek care, how quickly to seek care, and whether to continue or discontinue treatment. In Nigeria, high and unpredictable healthcare costs may discourage low-income households from seeking timely professional healthcare, contribute to delayed treatment, encourage self-medication, increase reliance on informal healthcare providers, and result in unmet healthcare needs. Understanding the relationship between healthcare costs and healthcare-seeking behaviour is therefore important for improving equitable access to healthcare and reducing financial barriers to healthcare utilization. Against this background, this study investigates the impact of healthcare costs on healthcare-seeking behaviour among low-income households in Nigeria. The study is anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Theory of Planned Behavior. Andersen's Behavioral Model explains healthcare utilization through predisposing characteristics, enabling resources, and healthcare needs, with household income and healthcare costs representing important enabling and constraining factors. The Health Belief Model explains how perceived susceptibility to illness, perceived severity, perceived benefits of seeking professional care, and perceived barriers, including financial costs, influence healthcare-seeking decisions. The Theory of Planned Behavior provides additional insight into how attitudes toward healthcare, perceived social expectations, and perceived behavioural control may influence decisions to seek and utilize healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how healthcare costs may influence healthcare-seeking behaviour among low-income households in Nigeria. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from low-income households in selected Nigerian communities using a structured interviewer-administered questionnaire and healthcare-seeking behaviour assessment tool. A multistage sampling technique will be employed to select states, local government areas, communities, households, and eligible adult household representatives. Healthcare costs will be assessed using indicators such as consultation fees, medicine costs, laboratory and diagnostic expenses, hospital charges, transportation expenses, healthcare-related informal payments where applicable, and total out-of-pocket expenditure associated with recent healthcare episodes. Respondents may also be asked to report healthcare costs as a proportion of household income or expenditure to provide an indication of the relative financial burden. Healthcare-seeking behaviour will be assessed using indicators such as whether professional healthcare was sought during recent illness, time taken to seek care, type of healthcare provider selected, use of self-medication, reliance on informal or traditional care, use of primary healthcare facilities, treatment continuation, and forgone or delayed healthcare. Descriptive statistics will be used to summarize household sociodemographic and economic characteristics, healthcare expenditure patterns, and healthcare-seeking behaviours. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of healthcare costs on healthcare-seeking behaviour. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that higher healthcare costs have a significant negative impact on appropriate healthcare-seeking behaviour among low-income households in Nigeria. Households facing higher healthcare costs are expected to demonstrate greater tendencies toward delayed healthcare-seeking, self-medication, use of informal healthcare providers, discontinuation of treatment, or foregoing healthcare altogether. High medicine costs, diagnostic expenses, transportation costs, and consultation charges are expected to constitute important financial barriers to timely utilization of professional healthcare. Conversely, households experiencing lower financial barriers are expected to demonstrate greater use of formal healthcare services and earlier healthcare-seeking when illness occurs. However, healthcare costs may interact with the availability and quality of services, health insurance coverage, household income, geographical accessibility, health beliefs, and perceived severity of illness. Consequently, reducing direct healthcare costs alone may not be sufficient to improve healthcare-seeking behaviour if households continue to face other access barriers. The study is expected to contribute to the literature on healthcare costs, healthcare-seeking behaviour, health financing, out-of-pocket expenditure, financial barriers to healthcare, healthcare utilization, health economics, and public health in Nigeria by providing empirical evidence on how healthcare costs influence the healthcare decisions of economically disadvantaged households. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Health Insurance Authority, state ministries of health, state health insurance agencies, National Primary Health Care Development Agency, healthcare providers, public health practitioners, health economists, development partners, and policymakers regarding strategies for reducing financial barriers to healthcare. The study will also provide evidence-based recommendations for strengthening health insurance coverage, improving financial protection mechanisms, reducing unnecessary out-of-pocket payments, expanding affordable primary healthcare services, improving access to essential medicines and diagnostics, and promoting equitable and timely healthcare-seeking behaviour among low-income households in Nigeria.

Keywords: Healthcare costs, healthcare-seeking behaviour, low-income households, Nigeria, healthcare utilization, out-of-pocket expenditure, health financing, financial barriers, health insurance, healthcare access, health economics, primary healthcare, health-seeking behaviour, public health.