Assessment of Out-of-Pocket expenditure in a Public Intensive Care Unit: A study from the South-South, Nigeria

Background: In Nigeria, intensive care unit (ICU) services are largely financed through out-of-pocket payments. This imposes a significant financial burden on patients and families, especially in public health institutions where health insurance coverage is minimal.

Aim: To assess the impact of out-of-pocket payment on the utilisation, outcomes, and financial burden of ICU care at the University of Port Harcourt Teaching Hospital, South-South Nigeria.

Methodology: A retrospective cross-sectional analysis of 1,500 ICU admissions from January 2022 to December 2024 was conducted. Patients were stratified into two categories based on total ICU costs: high-cost patients (top 5% by expenditure) and non-high-cost patients (remaining 95%). Demographic data, clinical outcomes, and cost parameters were analysed. Regression models were used to explore correlations between age, cost, and outcome. Ethical approval was obtained from UPTH Ethics Committee.

Results: High-cost patients (n=78; 5.2%) incurred average expenses of ₦5,000,000, commonly due to trauma, sepsis, and major surgical interventions. This group recorded higher mortality rates despite greater resource utilisation. No significant correlation was found between age and cost in this group (β = -0.0642, t = -0.486). In contrast, non-high-cost patients (n=1,422) incurred an average cost of ₦200,000. A positive correlation was observed between age and number of ICU admissions in this group (β = 3.335, t = 2.72), with older patients requiring more frequent but lower-cost interventions.

Conclusion: Out-of-pocket expenditure for ICU services in public hospitals places a disproportionate financial burden on a small subset of patients, often without corresponding improvements in outcomes. There is an urgent need for expanded insurance coverage, cost-containment strategies, and policy reforms to ensure equitable access to critical care in resource-limited settings.