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Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana

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  • Strupat, Christoph
  • Klohn, Florian

Abstract

This paper delivers empirical evidence on how transfers that serve as an informal insurance mechanism are affected by a formal and country-wide health insurance scheme. Using the fifth and fourth waves of the Ghanaian Living Standard Household Survey, we investigate the extent to which the implementation of the National Health Insurance Scheme affects health-related outcomes and making or receiving informal transfers. Our findings suggest that there is a reduction of out-of-pocket expenditures for health services and a significant crowding out of informal transfers. We conclude that the provision of formal health insurance does not only relieve ill individuals from out-of-pocket expenditures, but also their network partners from making informal transfers.

Suggested Citation

  • Strupat, Christoph & Klohn, Florian, 2018. "Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana," World Development, Elsevier, vol. 104(C), pages 212-221.
    • Handle: RePEc:eee:wdevel:v:104:y:2018:i:c:p:212-221
    DOI: 10.1016/j.worlddev.2017.11.004
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    Cited by:

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    2. Nikolov, Plamen & Bonci, Matthew, 2020. "Do public program benefits crowd out private transfers in developing countries? A critical review of recent evidence," World Development, Elsevier, vol. 134(C).
    3. Heath Henderson & Arnob Alam, 2022. "The structure of risk-sharing networks," Empirical Economics, Springer, vol. 62(2), pages 853-886, February.
    4. Hample, Kelsey C, 2021. "Formal insurance for the informally insured: Experimental evidence from Kenya," World Development Perspectives, Elsevier, vol. 22(C).
    5. Strupat, Christoph, 2021. "The preserving effect of social protection on social cohesion during the COVID-19 pandemic: Evidence from Kenya," IDOS Discussion Papers 33/2021, German Institute of Development and Sustainability (IDOS), revised 2021.
    6. Afriyie-Kraft, Lydia & Zabel, Astrid & Damnyag, Lawrence, 2020. "Adaptation strategies of Ghanaian cocoa farmers under a changing climate," Forest Policy and Economics, Elsevier, vol. 113(C).
    7. Keetie Roelen & Carmen Leon-Himmelstine & Sung Kyu Kim, 2022. "Chicken or Egg? A Bi-directional Analysis of Social Protection and Social Cohesion in Burundi and Haiti," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 34(3), pages 1216-1239, June.
    8. Will, Meike & Groeneveld, Jürgen & Lenel, Friederike & Frank, Karin & Müller, Birgit, 2023. "Determinants of Household Vulnerability in Networks with Formal Insurance and Informal Risk-Sharing," Ecological Economics, Elsevier, vol. 212(C).
    9. Lenel, Friederike & Steiner, Susan, 2020. "Formal insurance and solidarity. Experimental evidence from Cambodia," Journal of Economic Behavior & Organization, Elsevier, vol. 174(C), pages 212-234.
    10. Grimm, Michael & Hartwig, Renate & Reitmann, Ann-Kristin & Bocoum, Fadima Yaya, 2020. "Can informal redistribution withstand formal safety nets? Insights from urban-rural transfers in Burkina Faso," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-81-20, University of Passau, Faculty of Business and Economics.
    11. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    12. Strupat, Christoph, 2021. "The preserving effect of social protection on social cohesion during the COVID-19 pandemic: Evidence from Kenya," MPRA Paper 111501, University Library of Munich, Germany.
    13. Meike Will & Jürgen Groeneveld & Karin Frank & Birgit Müller, 2021. "Informal risk-sharing between smallholders may be threatened by formal insurance: Lessons from a stylized agent-based model," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-18, March.
    14. Strupat, Christoph & Farfán, Gabriela & Moritz, Laura & Negre, Mario & Vakis, Renos, 2021. "Obesity and food away from home: What drives the socioeconomic gradient in excess body weight?," Economics & Human Biology, Elsevier, vol. 43(C).
    15. Grimm, Michael & Hartwig, Renate & Reitmann, Ann-Kristin & Bocoum, Fadima Yaya, 2021. "Inter-household transfers: An empirical investigation of the income-transfer relationship with novel data from Burkina Faso," World Development, Elsevier, vol. 144(C).
    16. Halefom Yigzaw Nigus & Eleonora Nillesen & Pierre Mohnen, 2024. "The effect of weather index insurance on social capital: Evidence from rural Ethiopia," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 91(1), pages 121-159, March.
    17. Sandra Pellet & Marine De Talancé, 2023. "Labor Migrants at Risk: Formal and Informal Insurance Strategies among Central Asians in Moscow [Migrantes laborales en riesgo: estrategias de seguro formales e informales entre los centroasiáticos," Post-Print hal-04261417, HAL.
    18. Garcia-Mandicó, Sílvia & Reichert, Arndt & Strupat, Christoph, 2021. "The Social Value of Health Insurance: Results from Ghana," Journal of Public Economics, Elsevier, vol. 194(C).
    19. Nigus, Halefom & Nillesen, Eleonora & Mohnen, Pierre, 2018. "The effect of weather index insurance on social capital: Experimental evidence from Ethiopia," MERIT Working Papers 2018-007, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    20. Geng, Xin & Janssens, Wendy & Kramer, Berber & van der List, Marijn, 2018. "Health insurance, a friend in need? Impacts of formal insurance and crowding out of informal insurance," World Development, Elsevier, vol. 111(C), pages 196-210.
    21. Christoph Strupat, 2022. "Social Protection and Social Cohesion in Times of the COVID-19 Pandemic: Evidence from Kenya," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 34(3), pages 1320-1357, June.
    22. Strupat, Christoph & Rukundo, Emmanuel Nshakira & Reichert, Arndt R., 2024. "The impact of shock-responsive social cash transfers: Evidence from an aggregate shock in Kenya," Ruhr Economic Papers 1073, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.

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    More about this item

    Keywords

    Public health insurance; Informal transfer networks crowding out; Ghana;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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