IDEAS home Printed from https://ideas.repec.org/a/aea/aecrev/v111y2021i9p3035-63.html
   My bibliography  Save this article

The Challenges of Universal Health Insurance in Developing Countries: Experimental Evidence from Indonesia's National Health Insurance

Author

Listed:
  • Abhijit Banerjee
  • Amy Finkelstein
  • Rema Hanna
  • Benjamin A. Olken
  • Arianna Ornaghi
  • Sudarno Sumarto

Abstract

To investigate barriers to universal health insurance in developing countries, we designed a randomized experiment involving about 6,000 households in Indonesia who are subject to a government health insurance program with a weakly enforced mandate. Time-limited subsidies increased enrollment and attracted lower-cost enrollees, in part by reducing the strategic timing of enrollment to correspond with health needs. Registration assistance also increased enrollment, but increased attempted enrollment much more, as over one-half of households who attempted to enroll did not successfully do so. These findings underscore how weak administrative capacity can create important challenges in developing countries for achieving widespread coverage.

Suggested Citation

  • 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.
    • Handle: RePEc:aea:aecrev:v:111:y:2021:i:9:p:3035-63
    DOI: 10.1257/aer.20200523
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/doi/10.1257/aer.20200523
    Download Restriction: no
    File URL: https://doi.org/10.3886/E138701V1
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/aer.20200523.appx
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/aer.20200523.ds
    Download Restriction: Access to full text is restricted to AEA members and institutional subscribers.
    File URL: https://libkey.io/10.1257/aer.20200523?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Klein, Alexander & Crafts, Nicholas, 2023. "Unconditional Convergence in Manufacturing Productivity across U.S. States: What the Long-Run Data Show," CEPR Discussion Papers 18065, C.E.P.R. Discussion Papers.
    2. Malani, Anup & Holtzman, Phoebe & Imai, Kosuke & Kinnan, Cynthia & Miller, Morgen & Swaminathan, Shailender & Voena, Alessandra & Woda, Bartosz & Conti, Gabriella, 2021. "Effect of Health Insurance in India: A Randomized Controlled Trial," IZA Discussion Papers 14913, Institute of Labor Economics (IZA).
    3. Bhalotra, Sonia & Fernandez, Manuel, 2021. "The Right to Health and the Health Effects of Denials," The Warwick Economics Research Paper Series (TWERPS) 1376, University of Warwick, Department of Economics.
    4. Johannes G. Jaspersen, 2022. "When full insurance may not be optimal: The case of restricted substitution," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1249-1257, June.
    5. 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).
    6. Baillon, Aurélien & Capuno, Joseph & O'Donnell, Owen & Tan, Carlos Antonio & van Wilgenburg, Kim, 2022. "Persistent effects of temporary incentives: Evidence from a nationwide health insurance experiment," Journal of Health Economics, Elsevier, vol. 81(C).
    7. Thomas Rouyard & Yukichi Mano & Bocar Mamadou Daff & Serigne Diouf & Khadidiatou Fall Dia & Laetitia Duval & Josselin Thuilliez & Ryota Nakamura, 2022. "Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal," Post-Print halshs-03641124, HAL.
    8. Lakdawala, Leah K. & Martínez Heredia, Diana & Vera-Cossio, Diego A., 2023. "The Impact of Expanding Worker Rights to Informal Workers Evidence from Child Labor Legislation," IDB Publications (Working Papers) 12705, Inter-American Development Bank.
    9. Kathrin Durizzo & Kenneth Harttgen & Fabrizio Tediosi & Maitreyi Sahu & August Kuwawenaruwa & Paola Salari & Isabel Günther, 2022. "Toward mandatory health insurance in low‐income countries? An analysis of claims data in Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 31(10), pages 2187-2207, October.
    10. Stephen Kwasi Opoku Duku & Edward Nketiah‐Amponsah & Christine J. Fenenga & Wendy Janssens & Menno Pradhan, 2022. "The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment," Health Economics, John Wiley & Sons, Ltd., vol. 31(10), pages 2120-2141, October.
    11. Mona Balesh Abadi & Kevin Devereux & Farah Omran, 2023. "Correcting for transitory effects in RCTs: Evidence from the RAND Health Insurance Experiment," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 56(1), pages 288-305, February.

    More about this item

    JEL classification:

    • D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:aea:aecrev:v:111:y:2021:i:9:p:3035-63. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.