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Effect of Health Insurance in India: A Randomized Controlled Trial

Author

Listed:
  • Malani, Anup

    (University of Chicago)

  • Holtzman, Phoebe
  • Imai, Kosuke

    (Harvard University)

  • Kinnan, Cynthia

    (NBER)

  • Miller, Morgen

    (University of Chicago)

  • Swaminathan, Shailender

    (Brown University)

  • Voena, Alessandra

    (Stanford University)

  • Woda, Bartek

    (Amazon)

  • Conti, Gabriella

    (University College London)

Abstract

We report on a large randomized controlled trial of hospital insurance for above-poverty-line Indian households. Households were assigned to free insurance, sale of insurance, sale plus cash transfer, or control. To estimate spillovers, the fraction of households offered insurance varied across villages. The opportunity to purchase insurance led to 59.91% uptake and access to free insurance to 78.71% uptake. Access increased insurance utilization. Positive spillover effects on utilization suggest learning from peers. Many beneficiaries were unable to use insurance, demonstrating hurdles to expanding access via insurance. Across a range of health measures, we estimate no significant impacts on health.

Suggested Citation

  • 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).
    • Handle: RePEc:iza:izadps:dp14913
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    1. Bernard Black & José-Antonio Espín-Sánchez & Eric French & Kate Litvak, 2017. "The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality," American Journal of Health Economics, University of Chicago Press, vol. 3(3), pages 281-311, Summer.
    2. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    3. Jacob Goldin & Ithai Z. Lurie & Janet McCubbin, 2019. "Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach," NBER Working Papers 26533, National Bureau of Economic Research, Inc.
    4. Alan T. Sorensen, 2006. "Social learning and health plan choice," RAND Journal of Economics, RAND Corporation, vol. 37(4), pages 929-945, December.
    5. Jacob Goldin & Ithai Z Lurie & Janet McCubbin, 0. "Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach," The Quarterly Journal of Economics, Oxford University Press, vol. 136(1), pages 1-49.
    6. Robert Kaestner, 2021. "Mortality and Science: A Comment on Two Articles on the Effects of Health Insurance on Mortality," Econ Journal Watch, Econ Journal Watch, vol. 18(2), pages 192–211-1, September.
    7. Jeffrey R Kling & Jeffrey B Liebman & Lawrence F Katz, 2007. "Experimental Analysis of Neighborhood Effects," Econometrica, Econometric Society, vol. 75(1), pages 83-119, January.
    8. Haushofer, Johannes & Chemin, Matthieu & Jang, Chaning & Abraham, Justin, 2020. "Economic and psychological effects of health insurance and cash transfers: Evidence from a randomized experiment in Kenya," Journal of Development Economics, Elsevier, vol. 144(C).
    9. Diane Alexander, 2020. "How Do Doctors Respond to Incentives? Unintended Consequences of Paying Doctors to Reduce Costs," Journal of Political Economy, University of Chicago Press, vol. 128(11), pages 4046-4096.
    10. Hudgens, Michael G. & Halloran, M. Elizabeth, 2008. "Toward Causal Inference With Interference," Journal of the American Statistical Association, American Statistical Association, vol. 103, pages 832-842, June.
    11. Liu, Hong & Sun, Qi & Zhao, Zhong, 2014. "Social learning and health insurance enrollment: Evidence from China's New Cooperative Medical Scheme," Journal of Economic Behavior & Organization, Elsevier, vol. 97(C), pages 84-102.
    12. Alan T. Sorensen, 2006. "Social learning and health plan choice," RAND Journal of Economics, The RAND Corporation, vol. 37(4), pages 929-945, December.
    13. Jason Abaluck & Mauricio Caceres Bravo & Peter Hull: & Amanda Starc, 2021. "Mortality Effects and Choice Across Private Health Insurance Plans," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1557-1610.
    14. Shankar Prinja & Pankaj Bahuguna & Indrani Gupta & Samik Chowdhury & Mayur Trivedi, 2019. "Role of insurance in determining utilization of healthcare and financial risk protection in India," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
    15. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    16. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    17. Jonas Pendzialek & Dusan Simic & Stephanie Stock, 2016. "Differences in price elasticities of demand for health insurance: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(1), pages 5-21, January.
    18. Huh, Jason & Reif, Julian, 2017. "Did Medicare Part D reduce mortality?," Journal of Health Economics, Elsevier, vol. 53(C), pages 17-37.
    19. Gerard La Forgia & Somil Nagpal, 2012. "Government-Sponsored Health Insurance in India : Are You Covered?," World Bank Publications - Books, The World Bank Group, number 11957.
    20. Jessica Cohen & Pascaline Dupas, 2010. "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 1-45.
    21. 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.
    22. Abhijit Banerjee & Amy Finkelstein & Rema Hanna & Benjamin A. Olken & Arianna Ornaghi & Sudarno Sumarto, 2021. "The Challenges of Universal Health Insurance in Developing Countries: Experimental Evidence from Indonesia's National Health Insurance," American Economic Review, American Economic Association, vol. 111(9), pages 3035-3063, September.
    23. Amitabh Chandra & Evan Flack & Ziad Obermeyer, 2021. "The Health Costs of Cost-Sharing," NBER Working Papers 28439, National Bureau of Economic Research, Inc.
    24. James R. Hines & Richard H. Thaler, 1995. "The Flypaper Effect," Journal of Economic Perspectives, American Economic Association, vol. 9(4), pages 217-226, Fall.
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    Cited by:

    1. Anaka Aiyar & Naveen Sunder, 2024. "Health insurance and child mortality: Evidence from India," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 870-893, May.
    2. Zhichao Jiang & Kosuke Imai & Anup Malani, 2023. "Statistical inference and power analysis for direct and spillover effects in two‐stage randomized experiments," Biometrics, The International Biometric Society, vol. 79(3), pages 2370-2381, September.
    3. Dupas, Pascaline & Jain, Radhika, 2023. "Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India," Journal of Public Economics, Elsevier, vol. 220(C).
    4. Zhang, Yan & Zhao, Guangchuan & Gu, Hai, 2022. "Investing in health capital: Does medical insurance matter?," Research in International Business and Finance, Elsevier, vol. 61(C).
    5. Steven Wilkins Reeves & Shane Lubold & Arun G. Chandrasekhar & Tyler H. McCormick, 2024. "Model-Based Inference and Experimental Design for Interference Using Partial Network Data," Papers 2406.11940, arXiv.org.

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    More about this item

    Keywords

    health insurance; health; randomized controlled trial; spillovers;
    All these keywords.

    JEL classification:

    • O10 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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