Social security health insurance for the informal sector in Nicaragua: a randomized evaluation

Abstract

SUMMARYThis article presents the results from an experimental evaluation of a voluntary health insurance program for informal sector workers in Nicaragua. Costs of the premiums as well as enrollment location were randomly allocated. Overall, take-up of the program was low, with only 20% enrollment. Program costs and streamlined bureaucratic procedures were important determinants of enrollment. Participation of local microfinance institutions had a slight negative effect on enrollment. One year later, those who received insurance substituted toward services at covered facilities and total out-of-pocket expenditures fell. However, total expenditures fell by less than the insurance premiums. We find no evidence of an increase in health-care utilization among the newly insured. We also find very low retention rates after the expiration of the subsidy, with less than 10% of enrollees still enrolled after one year. To shed light on the findings from the experimental results, we present qualitative evidence of institutional and contextual factors that limited the success of this program.

The Role of Credit Scoring, Cost and Product Discrimination in Improving the Competitiveness of Jordanian Insurance Companies

“…That means the insurance is necessary product for insured because most insured in Jordan have to have compulsory insurance for their automobiles rather than other kinds of insurance. This result accords to (Nakata, 2007) and (Thornton, 2010). On the other words, the decreasing in premium contributes about 10 percent in improving the performance of insurance companies in order to attract the lion share from insured.…”

“…The different effects of influence factors in emerging countries from Europe and Asia, this paper concluded that the Urbanization, incomes and their distributions, and the population degree of education are relevant factors for the development of insurance sector. However, (Thornton et al, 2010) found the direct evidence about the importance of transaction costs in the health insurance for the informal sector in Nicaragua. The enrollment procedure for the health insurance they offer in Nicaragua normally requires about a day of work to complete.…”

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

“…18 The authors hypothesized this increase in spending was due to the nature of the insurance program, which gave medical facilities incentives to encourage more complex treatments. 19 Of the studies mentioned here and below, King et al (2009), Finkelstein et al (2011, Thornton et al (2010), Sine (1994), and the U.S. RAND experiment -Keeler (1992), Lohr et al (1986) and Manning (1987) -use experimental designs, while other studies use non-experimental approaches. 20 Thus, the decrease in total expenditures on health care is due to shifting care from private to public facilities and to decreased price of care, but not to a change in quantity of treatment.…”

“…We appreciate comments at seminars at USAID BASIS, UC Berkeley, CERDI and other presentations, and from Paul Gertler, Ronald Lee, Ted Miguel, several anonymous referees, and other colleagues and stakeholders. randomization in developing countries (Sine (1994), Thornton et al (2010)). …”

The effects of access to health insurance: Evidence from a regression discontinuity design in Peru

“…Thornton et al (2010) find that initial take-up of subsidized, but for-pay insurance "Seguro Facultativo de Salud" among informally employed individuals in Nicaragua was as low as 20%. Moreover, after the subsidy expired most individuals who previously signed up cancelled their insurance.…”