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

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  • Levine, David
  • Polimeni, Rachel
  • Ramage, Ian

Abstract

We randomize the insurance premium for the SKY micro-health insurance program in rural Cambodia, allowing us to estimate the causal effects of health insurance on economic, health care utilization, and health outcomes. SKY insurance has its greatest impact on economic outcomes. SKY also changed health-seeking behavior, increasing the use of covered public facilities and decreasing the use of uncovered private care for major illnesses. As expected, due to low statistical power, we did not find statistically significant impacts on health.

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  • Levine, David & Polimeni, Rachel & Ramage, Ian, 2016. "Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia," Journal of Development Economics, Elsevier, vol. 119(C), pages 1-15.
    • Handle: RePEc:eee:deveco:v:119:y:2016:i:c:p:1-15
    DOI: 10.1016/j.jdeveco.2015.10.008
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    3. Cramer, Kim Fe, 2023. "Bank presence and health," LSE Research Online Documents on Economics 119194, London School of Economics and Political Science, LSE Library.
    4. Malani, Anup & Holtzman, Phoebe & Imai, Kosuke & Kinnan, Cynthia & Miller, Morgen & Swaminathan, Shailender & Voena, Alessandra & Woda, Bartek & Conti, Gabriella, 2021. "Effect of Health Insurance in India: A Randomized Controlled Trial," IZA Discussion Papers 14913, Institute of Labor Economics (IZA).
    5. Florent BEDECARRATS & Isabelle GUERIN & François ROUBAUD, 2017. "L'étalon-or des évaluations randomisées : économie politique des expérimentations aléatoires dans le domaine du développement," Working Paper 753120cd-506f-4c5f-80ed-7, Agence française de développement.
    6. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.
    7. Macha, Raphael Rasiel, 2015. "Community Based Health Insurance Schemes and Protection of the Rural Poor: Empirical evidence from Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 3(2), July.
    8. Xiaoqi Zhang & Yi Chen & Yi Yao, 2021. "Dynamic information asymmetry in micro health insurance: implications for sustainability," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 46(3), pages 468-507, July.
    9. Bukari, Chei & Broermann, Shanaz & Okai, Davidson, 2021. "Energy poverty and health expenditure: Evidence from Ghana," Energy Economics, Elsevier, vol. 103(C).
    10. O'Donnell, Owen, 2024. "Health and health system effects on poverty: A narrative review of global evidence," Health Policy, Elsevier, vol. 142(C).
    11. Anup Malani & Cynthia Kinnan & Gabriella Conti & Kosuke Imai & Morgen Miller & Shailender Swaminathan & Alessandra Voena & Bartosz Woda, 2024. "Evaluating and Pricing Health Insurance in Lower-income Countries: A Field Experiment in India," NBER Working Papers 32239, National Bureau of Economic Research, Inc.
    12. Michael Hillebrecht & Stefan Klonner & Rainer Sauerborn & Alie Sié & Aurélia Souares, 2021. "The Demand for Health Insurance in a Poor Economy: Evidence from Burkina Faso," Economic Development and Cultural Change, University of Chicago Press, vol. 69(4), pages 1273-1300.
    13. Lau, Siew Yee & Parinduri, Rasyad & Lee, Yoong Hon, 2019. "Does Social Health Insurance Help Owners of Micro- and Small Firms Cope with Family Hardships? Evidence from Indonesia," MPRA Paper 95295, University Library of Munich, Germany.
    14. Hiroki Wakamatsu & Seiichi Fukui & Kana Miwa, 2019. "Heterogeneous Preferences for Micro Health Insurance Attributes in Rural Cambodia: Latent Class Analysis," Economics Bulletin, AccessEcon, vol. 39(4), pages 2963-2975.
    15. Buehler, Dorothee & Cunningham, Wendy, 2018. "Shocks, vulnerability and income generating capacity of rural households: Evidence from Southeast Asia," TVSEP Working Papers wp-010, Leibniz Universitaet Hannover, Institute for Environmental Economics and World Trade, Project TVSEP.
    16. Boutin, Delphine & Petifour, Laurene & Allard, Yvonne & Kontoubré, Souleymane & Ridde, Valéry, 2024. "Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso," IZA Discussion Papers 17094, Institute of Labor Economics (IZA).
    17. Rabbani, Atonu & Mehareen, Jeenat & Chowdhury, Imran Ahmed & Sarker, Malabika, 2022. "Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment," Social Science & Medicine, Elsevier, vol. 292(C).
    18. Hang Thu Nguyen-Phung & Hai Le, 2024. "Urbanization and Health Expenditure: An Empirical Investigation from Households in Vietnam," Economies, MDPI, vol. 12(6), pages 1-17, June.
    19. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    20. Simona Helmsmüller & Andreas Landmann, 2022. "Does free hospitalization insurance change health care consumption of the poor? Short-term evidence from Pakistan," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 47(1), pages 238-275, March.

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