Impact of Health Insurance Coverage on Healthcare Utilisation and Catastrophic Health Expenditure Among Households in Ondo State

Background: Health insurance is a key mechanism for improving healthcare access and providing financial protection against catastrophic health expenditure. Its impact in the South West geopolitical zone of Nigeria, specifically Ondo State, requires rigorous empirical evaluation at the household level. This study examines the impact of health insurance coverage on healthcare utilisation and catastrophic health expenditure in Ondo State. Methods: A cross-sectional comparative study enrolled 320 households, stratified by National Health Insurance Authority enrolment status, from six local government areas. Healthcare utilisation rates, out-of-pocket expenditure, and household financial catastrophe thresholds were compared between insured and uninsured households using propensity score-matched analysis. Results: Insured households demonstrated significantly higher rates of outpatient utilisation and preventive care uptake. Catastrophic health expenditure incidence was substantially lower among insured households. Despite insurance coverage, substantial co-payments remained a barrier for low-income insured families. Conclusion: Health insurance significantly improves healthcare utilisation and reduces financial vulnerability in Ondo State. Family medicine departments should advocate for universal coverage expansion and work with the National Health Insurance Authority to minimise co-payment barriers that limit access even among enrolled households. Keywords: health insurance, healthcare utilisation, catastrophic expenditure, Ondo State, financial protection