Empirical Assessment of the Effect of Community-Based Health Insurance on Healthcare Utilisation in Kwara State

Community-based health insurance schemes offer a pathway to universal health coverage for informal sector and rural populations outside formal NHIS enrolment, and their effect on healthcare utilisation in North Central Nigeria merits rigorous empirical evaluation. This study empirically assessed the effect of community-based health insurance enrolment on healthcare utilisation among rural households in Ilorin West and Asa LGAs, Kwara State. A cross-sectional comparative analytical design was employed, comparing healthcare utilisation between 240 CBHI-enrolled and 240 non-enrolled households matched on demographic characteristics through propensity score matching. Outcomes assessed included outpatient visit frequency in the preceding 12 months, hospitalisation rates, uptake of preventive services (immunisation, antenatal care, growth monitoring), and out-of-pocket health expenditure. Results showed that CBHI-enrolled households made significantly more outpatient visits (mean 4.6 versus 2.1 per year; p < 0.001) and had higher preventive service utilisation rates across all assessed services (p < 0.001). Hospitalisation rates were comparable between groups, but catastrophic health expenditure was significantly lower among enrolled households (14.2 percent versus 29.6 percent; p < 0.001). CBHI enrolment effects were largest for maternal and child health services. The study provides empirical evidence that CBHI significantly improves preventive service utilisation and reduces financial barriers in Kwara State, recommending sustained government subsidy and community mobilisation investment for CBHI expansion across North Central Nigeria. Keywords: community-based health insurance, healthcare utilisation, Kwara State, universal health coverage, North Central Nigeria