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Does health insurance improve health?

Author

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  • Fink, Günther
  • Robyn, Paul Jacob
  • Sié, Ali
  • Sauerborn, Rainer

Abstract

From 2004 to 2006, a community-based health insurance (CBI) scheme was rolled out in Nouna District, Burkina Faso, with the objective of improving access to health services and population health. We explore the random timing of the insurance rollout generated by the stepped wedge cluster-randomized design to evaluate the welfare and health impact of the insurance program. Our results suggest that the insurance had limited effects on average out-of-pocket expenditures in the target areas, but substantially reduced the likelihood of catastrophic health expenditure. The introduction of the insurance scheme did not have any effect on health outcomes for children and young adults, but appears to have increased mortality among individuals aged 65 and older. The negative health effects of the program appear to be primarily driven by the adverse provider incentives generated by the scheme and the resulting decline in the quality of care received by patients.

Suggested Citation

  • Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    • Handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1043-1056
    DOI: 10.1016/j.jhealeco.2013.08.003
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    1. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    2. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    3. Devadasan, Narayanan & Ranson, Kent & Van Damme, Wim & Acharya, Akash & Criel, Bart, 2006. "The landscape of community health insurance in India: An overview based on 10 case studies," Health Policy, Elsevier, vol. 78(2-3), pages 224-234, October.
    4. M. Grubb, 2003. "Editorial," Climate Policy, Taylor & Francis Journals, vol. 3(3), pages 189-190, September.
    5. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    6. De Allegri, Manuela & Sanon, Mamadou & Bridges, John & Sauerborn, Rainer, 2006. "Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa," Health Policy, Elsevier, vol. 76(1), pages 58-71, March.
    7. Hong Wang & Winnie Yip & Licheng Zhang & William C. Hsiao, 2009. "The impact of rural mutual health care on health status: evaluation of a social experiment in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 65-82, July.
    8. Matthew Jowett, 2003. "Do informal risk sharing networks crowd out public voluntary health insurance? Evidence from Vietnam," Applied Economics, Taylor & Francis Journals, vol. 35(10), pages 1153-1161.
    9. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    10. Morduch, Jonathan, 1999. "Between the State and the Market: Can Informal Insurance Patch the Safety Net?," The World Bank Research Observer, World Bank, vol. 14(2), pages 187-207, August.
    11. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    12. De Allegri, Manuela & Sanon, Mamadou & Sauerborn, Rainer, 2006. ""To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa," Social Science & Medicine, Elsevier, vol. 62(6), pages 1520-1527, March.
    13. Edmar L. Bacha (ed.), 1994. "Economics in a Changing World," International Economic Association Series, Palgrave Macmillan, number 978-1-349-23458-5, June.
    14. Pia Schneider & Kara Hanson, 2006. "Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro‐health insurance and user fees in Rwanda," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 19-31, January.
    15. Xavier Giné & Robert Townsend & James Vickery, 2008. "Patterns of Rainfall Insurance Participation in Rural India," The World Bank Economic Review, World Bank, vol. 22(3), pages 539-566, October.
    16. Atim, Chris, 1999. "Social movements and health insurance: a critical evaluation of voluntary, non-profit insurance schemes with case studies from Ghana and Cameroon," Social Science & Medicine, Elsevier, vol. 48(7), pages 881-896, April.
    17. Zhongliang Zhou & Jianmin Gao & Qinxiang Xue & Xiaowei Yang & Ju'e Yan, 2009. "Effects of Rural Mutual Health Care on outpatient service utilization in Chinese village medical institutions: evidence from panel data," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 129-136, July.
    18. Criel, Bart & Waelkens, Maria Pia, 2003. "Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?," Social Science & Medicine, Elsevier, vol. 57(7), pages 1205-1219, October.
    19. Robyn, Paul Jacob & Fink, Günther & Sié, Ali & Sauerborn, Rainer, 2012. "Health insurance and health-seeking behavior: Evidence from a randomized community-based insurance rollout in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 75(4), pages 595-603.
    20. Smith, Kimberly V. & Sulzbach, Sara, 2008. "Community-based health insurance and access to maternal health services: Evidence from three West African countries," Social Science & Medicine, Elsevier, vol. 66(12), pages 2460-2473, June.
    21. Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    22. Marcle Fafchamps, 1999. "Risk sharing and quasi-credit," The Journal of International Trade & Economic Development, Taylor & Francis Journals, vol. 8(3), pages 257-278.
    23. Sauerborn, R. & Nougtara, A. & Hien, M. & Diesfeld, H. J., 1996. "Seasonal variations of household costs of illness in Burkina Faso," Social Science & Medicine, Elsevier, vol. 43(3), pages 281-290, August.
    24. Asenso-Okyere, W. Kwadwo & Osei-Akoto, Isaac & Anum, Adote & Appiah, Ernest N., 1997. "Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingent valuation," Health Policy, Elsevier, vol. 42(3), pages 223-237, December.
    25. Basaza, Robert & Criel, Bart & Van der Stuyft, Patrick, 2008. "Community health insurance in Uganda: Why does enrolment remain low? A view from beneath," Health Policy, Elsevier, vol. 87(2), pages 172-184, August.
    26. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
    27. Dong, Hengjin & Mugisha, Frederick & Gbangou, Adjima & Kouyate, Bocar & Sauerborn, Rainer, 2004. "The feasibility of community-based health insurance in Burkina Faso," Health Policy, Elsevier, vol. 69(1), pages 45-53, July.
    28. Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
    29. Sauerborn, R. & Adams, A. & Hien, M., 1996. "Household strategies to cope with the economic costs of illness," Social Science & Medicine, Elsevier, vol. 43(3), pages 291-301, August.
    30. World Bank, 2010. "World Development Indicators 2010," World Bank Publications - Books, The World Bank Group, number 4373.
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    More about this item

    Keywords

    Health; Health insurance; Health-seeking behavior; Mortality; Provider incentives;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J17 - Labor and Demographic Economics - - Demographic Economics - - - Value of Life; Foregone Income

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