Who Needs Financial Protection? Evidence on Threshold-Disaggregated Catastrophic Health Expenditure and Poverty in Nigeria

Who Needs Financial Protection? Evidence on Threshold-Disaggregated Catastrophic Health Expenditure and Poverty in Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Who Needs Financial Protection? Evidence on Threshold-Disaggregated Catastrophic Health Expenditure and Poverty in Nigeria Chukwuma Agu, Dominic U. Nwanosike This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8759199/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract This study examines the prevalence of catastrophic OOP health spending among households in Nigeria following the Xu et al. ( 2003 ) framework using two benchmarks – total and non-food expenditures. Using data from the 2018/2019 Living Standards Survey, it disaggregates CHE incidence and concentration across six thresholds – 5%, 10%, 15%, 25%, 30% and 40% - to capture effects across heterogenous household income groups in the context of high poverty, informality, and limited social protection as obtains in Nigeria. The study finds that more than a fifth of households experience catastrophic spending at 15% threshold and below, and that this increases monotonically under both benchmarks as the threshold is lowered from 40% to 5%. As thresholds increase above 15%, incidence of catastrophic expenditure declines more noticeably, signalling constrained access to care and potential for forgone health services for the poor. Estimates of both incidence and concentration of the non-food benchmark indicate greater vulnerability of discretionary consumption to health shocks. The study finds that CHE is characterised by both frequent OOP payments at lower thresholds and by less common but severe shocks that overwhelm household resources at higher thresholds. Disproportionate financial fragility and CHE burden indicating financial distress from relatively modest health expenditures at lower thresholds (pro-poor CHE) appear to co-exist with less frequent but high-end health costs (pro-rich CHE) at higher thresholds. The study recommends differentiated policy responses that reflect the heterogeneity of household vulnerability which simultaneously incorporate early-stage financial distress among the poor as well as exposure to severe health shocks among wealthier households. Catastrophic Health Expenditure Out-of-Pocket Universal Health Concentration Index Poverty Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Mar, 2026 Reviews received at journal 19 Mar, 2026 Reviews received at journal 16 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviews received at journal 04 Mar, 2026 Reviewers agreed at journal 21 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers invited by journal 20 Feb, 2026 Editor invited by journal 06 Feb, 2026 Editor assigned by journal 04 Feb, 2026 Submission checks completed at journal 04 Feb, 2026 First submitted to journal 01 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8759199","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595848407,"identity":"64357985-0604-4243-a7b2-d45bb6eabf9d","order_by":0,"name":"Chukwuma Agu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBAC/hkMzAjeBwhlgFeLxA0kLYwziNFiEIGkhZmHKC3SPcbGvG3b5BnYj1+Ttm27k8fA3rxNgnFHLW4tMmeMk3nbbhs28OSUSee2PStm4DlWJsF45jhuLRI5xodz224zNjDkpAG1HE5skMgxk2BsO0ZQi30D/5s0aUuQFvk3BLRE5BgnA7UADU8/Js0ItoUHpKUGpxaJG2nFxn/O3U5uk3jDbNlz7nBiG09asUVi2wGcWvhnJG+WnFF227afP/3hjR9lhxP72Q9vvPGxrQ6nFjhgY+AxgDKAIIHhMGEtDAzsD5B5RNgyCkbBKBgFIwUAAMAVUnzTRkhfAAAAAElFTkSuQmCC","orcid":"","institution":"University of Nigeria","correspondingAuthor":true,"prefix":"","firstName":"Chukwuma","middleName":"","lastName":"Agu","suffix":""},{"id":595848410,"identity":"480a5913-ac0c-445e-bd95-9bb96935f4ac","order_by":1,"name":"Dominic U. 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