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Effect of Health Insurance Coverage on Access to Healthcare Services among Rural Households in Nigeria

Abstract

Health insurance coverage is an important component of health financing that can influence individuals' ability to obtain timely, affordable, and appropriate healthcare services. Health insurance provides financial protection by reducing the direct cost of healthcare and may encourage individuals and households to seek healthcare when needed. Access to healthcare services refers to the ability of individuals to obtain available, affordable, acceptable, and timely healthcare services when required. In Nigeria, rural households often experience substantial barriers to healthcare access, including poverty, high out-of-pocket healthcare expenditure, inadequate health facilities, shortage of healthcare personnel, long travel distances, transportation difficulties, and limited availability of essential medical services. These challenges may discourage households from seeking formal healthcare or result in delays in receiving appropriate treatment. The expansion of health insurance coverage, particularly through the National Health Insurance Authority (NHIA) and state-level health insurance programmes, is intended to improve financial protection and increase access to healthcare services. However, disparities in insurance enrolment and healthcare utilization remain between rural and urban populations. Consequently, there is a need to examine whether health insurance coverage translates into improved access to healthcare services among rural households in Nigeria. Against this background, this study investigates the effect of health insurance coverage on access to healthcare services among rural households in Nigeria. The study is anchored on Andersen's Behavioral Model of Health Services Use, the Grossman Model of Health Demand, and the Health Belief Model. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors, with health insurance serving as an important enabling factor that can facilitate healthcare utilization. The Grossman Model views healthcare as an investment in human capital and suggests that individuals' demand for healthcare is influenced by the expected benefits and costs associated with maintaining health. The Health Belief Model emphasizes individuals' perceptions of health needs, healthcare benefits, barriers, and the likelihood of seeking healthcare services. Collectively, these theoretical perspectives provide a framework for explaining how health insurance coverage may influence healthcare access among rural households in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from selected rural households using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select rural communities and households across selected states in Nigeria. Health insurance coverage will be measured using insurance enrolment status, type of health insurance scheme, duration of enrolment, coverage of household members, range of healthcare services covered, and perceived adequacy of insurance benefits. Access to healthcare services will be measured using healthcare utilization when illness occurs, use of formal healthcare facilities, ability to obtain needed medical treatment, affordability of healthcare services, distance to healthcare facilities, waiting time, and timeliness of receiving healthcare. Descriptive statistics will be used to summarize the demographic and socioeconomic characteristics of respondents and the distribution of health insurance coverage and healthcare access. Inferential statistical techniques, including chi-square tests, logistic regression, and multiple regression analysis, will be employed to determine the effect of health insurance coverage on access to healthcare services. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the estimated relationships. The study anticipates that health insurance coverage will have a significant positive effect on access to healthcare services among rural households in Nigeria. Insured households are expected to be more likely to utilize formal healthcare services when illness occurs because insurance reduces the financial burden associated with consultation, diagnosis, medication, hospitalization, and other healthcare costs. Insurance coverage may also reduce reliance on self-medication, informal treatment providers, and delayed care resulting from inability to pay. Furthermore, households with health insurance may be more likely to seek preventive and routine healthcare services because the direct financial cost of obtaining care is reduced. However, insurance coverage alone may not completely eliminate barriers to healthcare access among rural households. Poor availability of healthcare facilities, inadequate staffing, long travel distances, transportation difficulties, limited service availability, and delays in receiving care may continue to restrict access even among insured households. The effectiveness of health insurance in improving healthcare access is therefore expected to depend partly on the availability and quality of healthcare services within rural communities. This study is expected to make significant contributions to the literature on health financing, health services utilization, rural health, and public health in Nigeria by providing empirical evidence on the relationship between health insurance coverage and healthcare access among rural households. The findings will provide useful information for the National Health Insurance Authority (NHIA), state health insurance agencies, Federal and State Ministries of Health, local government health authorities, healthcare providers, development partners, and policymakers regarding the effectiveness of health insurance as a mechanism for improving healthcare access in rural communities. The study will also provide evidence-based recommendations for expanding health insurance enrolment, improving the benefit package available to rural households, reducing financial barriers to healthcare, strengthening rural healthcare facilities, improving provider availability, and promoting equitable access to quality healthcare services in Nigeria.

Keywords: Health insurance coverage, healthcare access, rural households, healthcare utilization, health financing, financial protection, rural health, healthcare services, Nigeria.