Out of pocket Expenditure

Background: Low back pain (LBP) is a global health challenge with a lifetime prevalence of 60-85%, being the leading cause of years lived with disability worldwide and significantly affecting African populations, including Nigeria. Physiotherapy is a crucial non-invasive treatment option for LBP management, offering various evidence-based interventions including exercise therapy, manual therapy, and electrotherapy. Nigeria's healthcare system faces significant challenges, with over 70% of healthcare expenses paid through out-of-pocket (OOP) payments due to limited insurance coverage and underfunding. This study aims to examine the out-of-pocket expenditures on physiotherapy for LBP in Benin City, Edo State, and its implications for healthcare access and policy. Method: A cross-sectional study design was used recruiting 99 participants. A non- probability purposive sampling technique was used to recruit participants. The sample size was determined using an online calculator with an 80% confidence level. Data was collected using self-administered questionnaires, with ethical approval obtained from UBTH’s Medical Advisory Committee. Data analysis was performed using SPSS version 22.0, employing descriptive statistics (mean, frequency, standard deviation) and chi-square test of independence, with significance level set at p<0.05. Result: The study involved 99 participants, predominantly female (58.6%), married (83.8%), and businesspersons (35.3%), with a mean age of 63.65 ± 17.59 years and 27.56 ± 9.72 years of work experience. The average total out-of-pocket expenditure was ₦127,527.58 ± 18,712.44, comprising direct medical costs (₦72,363.64 ± 15,048.53), direct non-medical costs (₦20,315.45 ± 6,006.12), and indirect costs (₦34,848.48 ± 8,638.26). Disability levels were moderate, with mean scores of 31.08 ± 2.61 (Oswestry Disability Index) and 31.06 ± 2.07 (Rolland Morris Disability Questionnaire). Gender comparisons showed females had slightly higher expenditures (₦130,051.72 ± 18,924.06) than males (₦123,956.83 ± 18,034.77), but differences were not statistically significant (p > 0.05). Conclusion: This study highlights the substantial economic burden of managing low back pain in tertiary healthcare facilities in Benin City, Edo State, with significant out-of-pocket expenditures for both direct and indirect costs. Despite these challenges, no significant gender differences in costs were observed.