EFFECT OF PLATEAU STATE CONTRIBUTORY HEALTHCARE SCHEME ON OUT-OF-POCKET EXPENDITURE AND CATASTROPHIC HEALTH SPENDING: A COMPARATIVE CROSS-SECTIONAL STUDY TOWARDS UNIVERSAL HEALTH COVERAGE IN NORTH-CENTRAL NIGERIA

Abstract

Background: Nigeria's health financing is characterized by high out-of-pocket expenditure (OOPE) accounting for 71.5% of total health expenditure, undermining Universal Health Coverage. Plateau State Contributory Healthcare Management Agency (PLASCHEMA) established 2019 but impact unquantified. Objective: To evaluate impact of PLASCHEMA on OOPE, catastrophic health expenditure (CHE) and impoverishment. Methods: Comparative cross-sectional with quasi-experimental Propensity Score Matching (PSM). Conducted in Jos North, Jos South and Mangu LGAs Jan-June 2025. Multistage sampling of 420 households with illness in last 90 days: 210 actively enrolled in PLASCHEMA ≥12 months and 210 non-enrolled matched by income quintile. Data collected using WHO-adapted health expenditure questionnaire via KoboCollect. Primary outcomes: mean OOPE, CHE at 10% total expenditure and 25% non-food expenditure thresholds, impoverishment at $2.15/day. Analysis with SPSS 28 and Stata 17 using t-test, chi-square, multivariate logistic regression and PSM for Average Treatment Effect on Treated (ATT). Results: Mean monthly income comparable: Enrolled ₦58,420 ±12,300 vs Non-enrolled ₦55,310 ±11,800 p=0.34. Mean OOPE significantly lower among enrolled: ₦4,850.60 ±2,124.30 vs ₦18,700.45 ±6,412.80 p<0.001. ATT showed reduction of ₦13,410 (95%CI: -15,200 to -11,620). CHE at 10% threshold 8.6% vs 31.4% adjusted OR 0.19 95%CI 0.10-0.35 p<0.001. CHE at 25% non-food threshold 3.8% vs 18.1% aOR 0.17 95%CI 0.07-0.39. Impoverishment 2.4% vs 14.3% aOR 0.14 95%CI 0.05-0.41. Residual OOPE among insured driven by non-formulary drugs 67.8%, diagnostic stock-outs 54.2%, informal payments 21.4%. Conclusion: PLASCHEMA provides significant financial risk protection reducing OOPE by 74% and CHE by over 70%. However residual OOPE persists due to supply-side gaps. Scale-up with supply-side reform needed. Keywords: Out-of-pocket; Catastrophic health expenditure; PLASCHEMA; Health insurance; Universal health coverage; Nigeria.