BACKGROUND:
The National Health Insurance Scheme was introduced to provide universal access to quality healthcare and protect Nigerians from financial hardship. However, its limited coverage left the majority of citizens dependent on out-of-pocket payments. To address this gap, the Lagos State Health Insurance Scheme was established to ensure equitable access to healthcare for all residents, regardless of their economic status. Despite this policy goal, significant disparities persist in service quality, accessibility, and affordability. This study examines how legislative oversight has influenced the implementation of the LSHIS and explores the gap between health policy design and practice in achieving equity.

METHODS:
A qualitative approach was adopted, combining interviews with legislators, Lagos State Health Management Agency officials, and healthcare providers with a review of relevant policy documents and literature. Data were thematically analysed to identify patterns in oversight, service delivery, and equity outcomes.

RESULTS:
Findings revealed diverse stakeholder perspectives on barriers to equitable healthcare. Poor service quality, persistent out-of-pocket payments, and provider bias against state insurance enrollees undermine the scheme’s objectives. While the Lagos State House of Assembly performs active oversight, systemic issues, such as inadequate funding, weak accountability structures, and executive interference, limit the effective implementation of policies. These factors collectively contribute to a widening gap between the intent of health policy and its actual outcomes.

CONCLUSIONS:
The study finds that despite legislative commitment to improving healthcare access, systemic constraints hinder policy outcomes. Strengthening accountability, broadening coverage, and improving collaboration with implementing agencies are essential for achieving equitable and affordable healthcare under the Lagos State Health Scheme.