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Social security health insurance for the informal sector in Nicaragua: a randomized evaluation
Author(s) -
Thornton Rebecca L.,
Hatt Laurel E.,
Field Erica M.,
Islam Mursaleena,
Solís Diaz Freddy,
González Martha Azucena
Publication year - 2010
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.1635
Subject(s) - fell , subsidy , microfinance , business , social security , health insurance , randomized experiment , demographic economics , disability insurance , health care , actuarial science , economic growth , economics , medicine , geography , cartography , pathology , market economy
This article presents the results from an experimental evaluation of a voluntary health insurance program for informal sector workers in Nicaragua. Costs of the premiums as well as enrollment location were randomly allocated. Overall, take‐up of the program was low, with only 20% enrollment. Program costs and streamlined bureaucratic procedures were important determinants of enrollment. Participation of local microfinance institutions had a slight negative effect on enrollment. One year later, those who received insurance substituted toward services at covered facilities and total out‐of‐pocket expenditures fell. However, total expenditures fell by less than the insurance premiums. We find no evidence of an increase in health‐care utilization among the newly insured. We also find very low retention rates after the expiration of the subsidy, with less than 10% of enrollees still enrolled after one year. To shed light on the findings from the experimental results, we present qualitative evidence of institutional and contextual factors that limited the success of this program. Copyright © 2010 John Wiley & Sons, Ltd.