Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia

Levine, David I.; Polimeni, Rachel; Ramage, Ian

doi:10.1016/j.jdeveco.2015.10.008

Cited by 61 publications

(62 citation statements)

References 19 publications

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“…Eligible households can purposefully select their household members to be insured and pay the insurance premium only for them. [21][22][23][24][25] This adverse selection could lead to the situation that the people insured are more likely to be in need of health care. Therefore, a key target in the National health financing strategy to move towards universal health coverage is to make enrolment mandatory and the health financing system more centralized in Senegal.…”

Section: Discussionmentioning

confidence: 99%

Reforms for financial protection schemes towards universal health coverage, Senegal

Daff

Diouf

Diop

et al. 2019

Bull. World Health Organ.

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Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country.

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Section: Discussionmentioning

confidence: 99%

Reforms for financial protection schemes towards universal health coverage, Senegal

Daff

Diouf

Diop

et al. 2019

Bull. World Health Organ.

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“…Previous evaluations of the impacts of micro health insurance policies have described effects along these lines: De Bock and Ontiveros (2013), in their review of the impact of microinsurance, highlighted that most studies on health insurance have found significant decreases in out-of-pocket expenses of subscribers. Levine and Polimeni (2012) and Aggarwal (2010) (among others) also found that insured households were less likely to sell assets or take up informal loans after a health shock. We know of only one other study on the effects of index insurance on ex-post risk-coping strategies: Janzen and Carter (2013) found that in a drought-affected region of Kenya, pastoralists who subscribed to an index-based insurance policy were significantly less likely to report anticipating having to sell livestock or reduce consumption as a response to weather shocks.…”

Section: Introductionmentioning

confidence: 97%

Insuring farmers against weather shocks: evidence from India

Tobacman¹,

Stein²,

Shah³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, for whom, how, why and at what cost. We believe that better and policy-relevant evidence will help make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Insuring farmers against weather shocks: evidence from India, as partial fulfilment of the requirements of grant OW3.1171 awarded under Open Window 3. The report has been formatted to 3ie standards. However, despite best efforts in working with the authors, some references are still missing and figures and tables could not be improved. We have copy-edited the content to the extent possible. These efforts caused a delay in publishing this report, which is why the series number and date are out of sequence.All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are the sole responsibility of the authors. Please direct any comments or queries to the corresponding author, Jeremy Tobacman, at tobacman@wharton.upenn.edu Funding for this impact evaluation was provided by 3ie's donors, which include UK Aid, the Bill & Melinda Gates Foundation and the Hewlett Foundation. A complete listing of all of 3ie's donors is available on the 3ie website. SummaryWith weather risk a key source of income vulnerability for many of the 2.5 billion people around the world who derive their income from smallholder agriculture, rainfall insurance represents a potentially important product innovation.This study performs a rigorous evaluation of the long-term impacts of rainfall insurance access and coverage on agricultural investment and outcomes, consumption and wellbeing proxies using a randomised controlled trial design. Main findingsWe find no systematic, long-term effect of insurance access or adoption on agricultural investment decisions. There is also little to no statistical difference in reported agricultural revenues and profits. This is true even though (randomly assigned) subsidies caused households that purchased insurance policies to experience greater financial income from insurance payouts than financial costs from insurance premiums. These findings suggest that the insurance products studied were not sufficient to induce farmers to adopt theoretically promising alternative investments, such as high-yielding variety crops.Demand for rainfall insurance among study households was moderate. Depending on the...

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“…Consistent with the pattern that idiosyncratic health shocks are better insured by informal risksharing networks than covariate weather shocks to agricultural production (Townsend, 1994;Udry, 1994), health insurance take-up and the potential of subsidization have been found to be even lower in several middle-income country contexts (Thornton et al, 2010;Capuno et al, 2016;Levine et al, 2016;Wagstaff et al, 2016). 2…”

Section: Introductionmentioning

confidence: 81%

“…There is some evidence for selection on risk in that demand of ill individuals is more price-sensitive (the opposite of adverse selection in the sense of Rothschild and Stiglitz, 1976). Two further papers, Levine et al (2016) and Thornton et al (2010) mention similar effects of subsidization on enrollment among a subgroup of self-selected households in rural Cambodia and urban informal workers in Nicaragua, respectively. Their primary focus is on health care facility utilization and health-related household expenditures, however.…”

Section: The Intervention: Targeted Subsidized Health Insurancementioning

confidence: 99%

The Demand for Health Insurance in a Poor Economy: Evidence from Burkina Faso

Hillebrecht

Klonner

Sauerborn

et al. 2021

Economic Development and Cultural Change

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We investigate the properties of health insurance demand in Burkina Faso, where we offered poor households a voluntary health insurance product at half the usual price. The targeting procedure we implemented delivers a fuzzy regression discontinuity design, which identifies the price elasticity of demand for health insurance as well as associated selection effects. We find large price elasticities among urban households, whereas the demand of rural households is price-inelastic. There are important selection effects, with widowed male household heads being most price-sensitive. Correlating these heterogeneous effects with survey data on informal transfers and health expenditures, our results suggest that informal risk-sharing largely crowds out formal insurance and that a single insurance product may fail to align with poor households' small health budgets. We find no adverse selection into health insurance.

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Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia

Cited by 61 publications

References 19 publications

Reforms for financial protection schemes towards universal health coverage, Senegal

Reforms for financial protection schemes towards universal health coverage, Senegal

Insuring farmers against weather shocks: evidence from India

The Demand for Health Insurance in a Poor Economy: Evidence from Burkina Faso

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