Knowledge, accessibility and uptake of national health insurance authority and the negative economic effects of non-users in a rural community in South Western

Background: The National Health Insurance Authority (NHIA) was established to reduce out-of-pocket (OOP) spending and improve healthcare access in Nigeria. Despite its potential, access to the scheme remains limited, especially in semi-urban communities like Ido-Ekiti, Ekiti State, leading to potential economic burdens. This study assessed the economic effects of inaccessibility to the NHIA among residents of Ido-Ekiti, Ekiti State. Materials/Methods: A descriptive cross-sectional study was conducted among 415 residents aged 18 years and above in Ido-Ekiti. Participants were selected using a multistage sampling method with probability proportionate to size (PPS). Data were collected over eight weeks using self-administered questionnaires and analyzed using IBM SPSS version 25. Results: Out of 415 respondents, 30.9% were aged 35–44 years. While 64.7% were aware of health insurance, 61.8% had poor knowledge of it. Only 17.4% were enrolled in NHIA. A significant proportion (52.0%) reported economic challenges linked to healthcare inaccessibility, including delayed care and borrowing money for medical bills. Most respondents attributed these challenges to OOP health expenditures due to non-enrollment. Conclusion: Despite relatively high awareness, poor knowledge and limited access to NHIA persist, contributing to economic hardship among residents. Strengthening awareness, improving service quality, and establishing trust-building mechanisms are essential for expanding NHIA uptake.