Empirical Study of the Relationship Between Social Health Insurance and Healthcare Utilisation in Ogun State

Social health insurance coverage determines equitable access to healthcare, and empirically characterising the relationship between NHIA enrolment and healthcare utilisation in Ogun State provides evidence for universal health coverage policy. This study empirically examined the relationship between NHIA social health insurance enrolment and healthcare utilisation patterns among adults in Abeokuta North, Remo North, and Egbado North Local Government Areas, Ogun State. A cross-sectional survey of 480 adults (240 NHIA-enrolled, 240 non-enrolled) was conducted using propensity score matching to create comparable groups. Healthcare utilisation was measured through formal facility visit frequency in the preceding six months, treatment completion rates, and preventive care uptake. Propensity score matched analysis showed that NHIA-enrolled respondents visited formal health facilities 2.8 times more frequently than non-enrolled counterparts (p < 0.001). Treatment completion rates were 76.4 percent for enrolled versus 51.3 percent for non-enrolled respondents. Preventive care uptake (antenatal, vaccination, routine checkup) was 44.7 percent higher among enrolled adults. The coverage-utilisation effect was strongest among the poorest wealth quintile, suggesting that insurance provides the greatest benefit where out-of-pocket barriers are highest. The study fills an empirical gap in Ogun State health insurance research and recommends expanding NHIA coverage to informal sector workers, rural communities, and self-employed individuals as the primary UHC expansion strategy. Keywords: social health insurance, NHIA, healthcare utilisation, Ogun State, universal health coverage