ORIGINAL PAPER Determinants of catastrophic health expenditure in Nigeria Bolaji Samson Aregbeshola 1 • Samina Mohsin Khan 2 Received: 11 January 2017 / Accepted: 17 May 2017 Ó Springer-Verlag Berlin Heidelberg 2017 Abstract Background Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria. Methods Secondary data from the Harmonized Nigeria Liv- ing Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associ- ated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression. Results Results showed that irrespective of the threshold for the two concepts of total household expenditure and non- food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary educa- tion, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households. Conclusions Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy. Keywords Out-of-pocket payments Á Catastrophic health expenditure Á Harmonized Nigeria Living Standard Survey Á Financial risk protection Á Health equity JEL Classification I19 Introduction Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. Catastrophic health expenditure has been defined as a state when out-of-pocket payments cross estimated threshold share of household expenditure at which the household is forced to sacrifice their basic needs, sell their assets, incur unwarranted debt, or become impoverished [1–3]. There is no consensus in the existing literature and among health economists on the threshold proportion of household expenditure. However, there is an agreement that catastrophic health expenditure is medical spending or out-of-pocket expenditure that exceeds a defined threshold of a household’s total consumption or non-food consumption expenditure annually [1–5]. Dif- ferent thresholds have been used by researchers to estimate catastrophic health expenditure in different countries [6]. Some studies have used 10% threshold of total household expenditure [3, 7] while others have used 40% of non-food consumption expenditure [5, 8]. Globally, many house- holds incur catastrophic health expenditure and are pushed & Bolaji Samson Aregbeshola bolajiaregbeshola74@gmail.com Samina Mohsin Khan mominsmahnoor@gmail.com 1 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Mushin, Lagos, Nigeria 2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden 123 Eur J Health Econ DOI 10.1007/s10198-017-0899-1