Getting the Poor to Enroll in Health Insurance and its Effects on their Health: Evidence from a Randomized Field Experiment in Ghana

Investigators: CDEP Fellow Patrick Asuming and Hyuncheol Kim

Many developing countries have instituted social health insurance schemes to help mitigate the effects of adverse health shocks on the poor but take-up of such schemes remain low even though many of them offer generous terms and benefits. This project implemented randomized field interventions to understand the reasons for low enrollment. The project randomly gave subsidies and information to poor rural households in one of Ghana’s poorest districts to encourage enrollment in Ghana’s social health insurance program, the National Health Insurance Scheme. The experimental design also allows the project to use the random variation in insurance take-up to estimate the effects of insurance coverage on utilization of healthcare, financial protection and health.

The initial results show that imperfect information, and insurance premium and fees affect enrollment. The results also showed that that insurance coverage led to increased utilization of healthcare services, reduced out-of-pocket payments among individuals with prior positive expenses and improved in health outcomes. Moreover, there is strong evidence of complementarities between providing information and providing subsidies in utilization and health outcomes, an indication of the importance of the combined interventions for achieving changes in health-seeking behavior and outcomes.

The project is currently investigating the long-term impact of these one-time interventions on re-enrollment and health outcomes three years after the original interventions.

This project is currently available as IZA Institute for Labor Economics discussion paper #11117.

This project is part of CDEP's Human Capital Initiative.