This study examined the socio-economic and geographic differences in illness
occurrence and levels of expenditures in South Eastern Nigeria, together with policymaker and
healthcare provider views on how to alleviate the financial burdens placed on the poorest by
existing payment mechanisms. We found no evidence of differences across socio-economic
group in illness occurrence but there was inequity in expenditures, payment mechanisms used
and sources of funds to cope with the burden of payments. Policymakers and facility managers
were found to assume that households have the capacity to cope with healthcare payments and
there is no functioning system of fee exemptions. Policies are needed to protect the poor and
other vulnerable groups against the financial risk of ill-health. Copyright # 2009 John Wiley
& Sons, Ltd.