Improving Takeup of Health Insurance Program: A Social Experiment in France

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.…”

“…Thornton et al (2010) found substantial effects on enrollment (31 percentage points-a 500% increase),Capuno et al (2014) found a three percentage point (37%) increase in enrollment though not quite significant at the 10% level (p = 0.11), whileGuthmuller et al (2014) found a negligible and insignificant effect. However, the study byGuthmuller et al (2014) is not completely comparable with the other two. The result above refers to the group who, in addition to receiving the letter about the scheme and a subsidy offer, also received an invitation to a meeting to learn more about the program.…”

“…In Nicaragua, enrollment among informal‐sector workers receiving a brochure and a subsidy was 31 percentage points (ppt) higher than that of the control group (6% of whom enrolled), while those receiving only the brochure were 5 ppts less likely to enroll than the control group; in a sub‐experiment, offering on‐site enrollment raised enrollment by 22–36 ppt (Thornton et al ., ). In France, those receiving an increased subsidy for a program targeted at the poorest 7% of French households were 2.7 ppt (17%) more likely to apply for complementary insurance than the control group (16% of whom completed the form), while those who, in addition to receiving the offer of a higher subsidy, also received the invitation to the information session were no more likely to complete the application form than the control group (Guthmuller et al ., ).…”

Effects of Price, Information, and Transactions Cost Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Randomized Experiment in the Philippines

“…Our study adds to the small experimental literature on the effects of information and premium subsidies on voluntary enrollment in government‐run SHI schemes, and complements the study by Wagstaff et al () which was undertaken in parallel to this study. In terms of impacts of a combined information and subsidy intervention, our study comes out somewhere in the middle of the literature to date: Thornton et al () found substantial effects on enrollment (31 percentage points – a 500% increase), Guthmuller et al () found a negligible and insignificant effect, while Wagstaff et al () found a small (one percentage point) but insignificant effect. The stronger effects we observe in the urban population, combined with our sub‐experiment results, are consistent with the findings of the enrollment simplication sub‐experiment reported by Thornton et al: they found that allowing onsite enrollment doubled the enrollment rate (a 36 percentage point increase) among those receiving an information brochure and a subsidy; among those receiving only a brochure, onsite enrollment raised enrollment from just 1% to 23%.…”

The Impact of the Eligibility Threshold of a French Means‐Tested Health Insurance Programme on Doctor Visits: A Regression Discontinuity Analysis

“…However, little is known about poor individuals who are not eligible for the free plan. In fact, individuals with an income just above the CMUC threshold are poorly covered by a CHI plan, despite the 2004 introduction of a voucher (called Aide Complémentaire Santé, ACS) to financially help individuals with an income up to 35% (since January 2013) above the CMUC cut-off point to purchase a CHI plan (Guthmuller et al, 2014). Access to primary care thus remains expensive for those individuals (Jusot and Wittwer, 2009;Perronnin et al, 2011).…”