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Improving take-up of health insurance program: a social experiment in France

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  • Sophie Guthmuller

    (LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique)

  • Florence Jusot

    (LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique)

  • Jérôme Wittwer

    (LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique)

Abstract

This paper is based on a randomised social experiment conducted in order to understand the low take-up rate of a Complementary health-insurance voucher program for the poorest in France (the Aide Complémentaire Santé: ACS). We explore two of the main hypotheses put forward to explain low enrolment: a lack of information about the program and a voucher amount considered to be too low. A sample of eligible individuals living in an urban area in Northern France were randomly split into three groups: a control group who benefited from the standard level of financial aid; a group benefiting from an increase in the value of the voucher; and a third group benefiting from the same increase along with an invitation to an information meeting regarding ACS. We show that the voucher increase has a small but statistically significant effect on ACS take-up. The invitation to the meeting appears to cancel out the positive effect of the voucher increase. Using an instrumental variable model to control for potential selection bias, we find ambiguous evidence of the meeting attendance on ACS take-up. This study confirms the difficulties that are faced in increasing the health insurance coverage of poor populations via subsidy programs.

Suggested Citation

  • Sophie Guthmuller & Florence Jusot & Jérôme Wittwer, 2014. "Improving take-up of health insurance program: a social experiment in France," Post-Print hal-01523961, HAL.
    • Handle: RePEc:hal:journl:hal-01523961
    DOI: 10.3368/jhr.49.1.167
    Note: View the original document on HAL open archive server: https://hal.science/hal-01523961
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    Cited by:

    1. Rudy Douven & Pieter Bakx & Frederik T. Schut, 2016. "Does independent needs assessment limit supply-side moral hazard in long-term care?," CPB Discussion Paper 327.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    2. Arrighi, Y. & Rapp, T. & Sirven, N., 2017. "The impact of economic conditions on the disablement process: A Markov transition approach using SHARE data," Health Policy, Elsevier, vol. 121(7), pages 778-785.
    3. Rodolphe Durand & Marieke Huysentruyt, 2022. "Communication frames and beneficiary engagement in corporate social initiatives: Evidence from a randomized controlled trial in France," Strategic Management Journal, Wiley Blackwell, vol. 43(9), pages 1823-1853, September.
    4. Bakx, Pieter & Douven, Rudy & Schut, Frederik T., 2021. "Does independent needs assessment limit use of publicly financed long-term care?," Health Policy, Elsevier, vol. 125(1), pages 41-46.
    5. Arrighi, Yves & Davin, Bérengère & Trannoy, Alain & Ventelou, Bruno, 2015. "The non-take up of long-term care benefit in France: A pecuniary motive?," Health Policy, Elsevier, vol. 119(10), pages 1338-1348.
    6. Hagen, Johannes & Malisa, Amedeus, 2022. "Financial fraud and individual investment behavior," Journal of Economic Behavior & Organization, Elsevier, vol. 203(C), pages 593-626.
    7. Pierre, Aurélie & Jusot, Florence, 2017. "The likely effects of employer-mandated complementary health insurance on health coverage in France," Health Policy, Elsevier, vol. 121(3), pages 321-328.
    8. Sophie Guthmuller & Jérôme Wittwer, 2017. "The Impact of the Eligibility Threshold of a French Means‐Tested Health Insurance Programme on Doctor Visits: A Regression Discontinuity Analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 17-34, December.
    9. Adam Wagstaff & Ha Thi Hong Nguyen & Huyen Dao & Sarah Bales, 2016. "Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 663-674, June.
    10. Giles, John & Meng, Xin & Xue, Sen & Zhao, Guochang, 2021. "Can information influence the social insurance participation decision of China's rural migrants?," Journal of Development Economics, Elsevier, vol. 150(C).
    11. Per Engström & Eskil Forsell & Johannes Hagen & Arnaldur Stefánsson, 2019. "Increasing the take-up of the housing allowance among Swedish pensioners: a field experiment," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 26(6), pages 1353-1382, December.
    12. Joseph J. Capuno & Aleli D. Kraft & Stella Quimbo & Carlos R. Tan & Adam Wagstaff, 2016. "Effects of Price, Information, and Transactions Cost Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Randomized Experiment in the Philippines," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 650-662, June.
    13. Aurélie Pierre & Florence Jusot, 2015. "Une évaluation ex ante de la généralisation de la complémentaire santé d’entreprise sur les inégalités et les déterminants de la non-couverture," Working Papers DT67, IRDES institut for research and information in health economics, revised Jul 2015.
    14. Nyman, Pär & Aggeborn, Linuz & Ahlskog, Rafael, 2023. "Filling in the blanks: How does information about the Swedish EITC affect labour supply?," Labour Economics, Elsevier, vol. 85(C).
    15. Rudy Douven & Pieter Bakx & Frederik T. Schut, 2016. "Does independent needs assessment limit supply-side moral hazard in long-term care?," CPB Discussion Paper 327, CPB Netherlands Bureau for Economic Policy Analysis.
    16. Raf Van Gastel & Tim Goedemé & Julie Janssens & Eva Lefevere & Rik Lemkens, 2017. "A Reminder to Pay Less for Healthcare: take-up of Increased Reimbursement in a large-scale randomized field experiment," Working Papers 1712, Herman Deleeck Centre for Social Policy, University of Antwerp.

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