Effects of Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Cluster Randomized Trial

Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam

“…We know from demand‐side experiments in other areas of health policy that the size of the incentive can matter: for example, de Walque et al (), in their randomized controlled trial of financial incentives to stay free from sexually transmitted infections found that an effect of incentives only at the higher of the two incentive levels implemented. We do not have evidence from the health insurance field on the effect of varying the level of subsidy, and while previous and parallel studies have offered more generous subsidies than we did in this experiment, the effects on enrollment have been varied: Thornton et al () offered a 50% subsidy and found a statistically significant 500% effect, Capuno et al () offered a 50% subsidy and found a statistically insignificant 37% effect, while Guthmuller et al () offered a subsidy supplement of around 70% and found a statistically significant 17% effect. Future research could usefully use a variety of subsidy rates to assess the responsiveness of enrollment to variations in the subsidy rate.…”

“…Our study contributes to the small experimental literature reviewed previously on the effects of information and premium subsidies on voluntary enrollment in government‐run SHI schemes and complements the study by Capuno et al (), which was undertaken in parallel to this study. Our finding that information by itself has a negligible effect on enrollment is consistent with other studies.…”

“…Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. 1 The study by Capuno et al (2014) is excluded from this list-it was undertaken in parallel to the present study. 2 Our sample was a convenience sample stratified by level of government (commune, district, province, and national) and area of responsibility (health insurance, health service provision, and planning), with one leader per cell.A.…”

Uptake of health insurance and the productive safety net program in rural Ethiopia

“…The missing-middle problem describes the phenomenon where mandatory enrolment of formal sector workers is combined with subsidized premiums targeted to the poorest, while insurance uptake for the remainder of the informal sector relies to some extent on voluntary enrolment. International experiences suggest that it is extremely difficult to convince informal sector households to enrol voluntarily into health insurance, without providing strong (monetary) incentives to do so (Capuno et al 2014 andWagstaff et al 2014). However, there is no empirical evidence on 3 the effectiveness of policy instruments that leverage insurance uptake for the informal sector by integrating social policies.…”

Social connections and tertiary health‐care utilization

“…In India, only 15% of households have any health insurance coverage, and efforts to increase adoption have been largely unsuccessful. For example,Rajasekhar et al (2011) illustrate challenges associated with RSBY take-up Capunoa et al (2014). evaluate impacts of two interventions designed to increase enrollment in the Philippines Individual Payer Program.2 Tumbe (2018) shows that permanent outmigration in India during the time we study is primarily from the states of Uttar Pradesh and Bihar, not Andhra Pradesh.3 We henceforth use "groups" to describe individuals of the same caste category.…”