Effects Of Basic Health Care Provision Fund Health Insurance On Healthcare Access And Utilization In Adamawa State: Evidence From Structural Equation And Thomas & Penchansky Models

Abstract

Nigeria's path to Universal Health Coverage is hindered by law access, financial and systemic challenges, notably impacting vulnerable populations. Basic Health Care Provision Fund (BHCPF) health insurance, a safety-net intervention in Nigeria, aims to enhance access to and utilisation of healthcare services for the vulnerable. This study examines the influence of the BHCPF health insurance on healthcare access and utilisation, among the vulnerable in Adamawa State. Data were collected from 793 BHCPF health insurance beneficiaries via a cross-sectional survey in Adamawa State between January and June 2025. A multistage sampling approach was used to determine the sample size. Structural Equation Modelling based on the Thomas Model for healthcare access was applied for the measurement of the structural relationships among the study latent variables. The variables are; BHCPF, healthcare access and utilisation (AccessUHC), frequency of healthcare facility visits (AUHC1), availability and ease of access to services (AUHC2) and coverage of health needs of the beneficiaries by the BHCPF (AUHC3). Model fit indices and standardised path coefficients were also conducted. The results indicate that the BHCPF health insurance significantly enhances healthcare access and utilisation for the vulnerable in Adamawa State. Thus; AUHC1- β =0.71 p-value 0.001, AUHC2- β= 0.64 p-value 0.000-AUHC3 β = 0.82 p-value0.000. This study emphasises the significance of BHCPF health insurance as a safety net in improving healthcare access for vulnerable populations. It recommends effective policies to enhance the implementation of BHCPF health insurance in Adamawa State and beyond, for optimising the intervention's impact on healthcare access and utilisation.