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Health insurance and health-seeking behavior: Evidence from a randomized community-based insurance rollout in rural Burkina Faso

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  • Robyn, Paul Jacob
  • Fink, Günther
  • Sié, Ali
  • Sauerborn, Rainer
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    Abstract

    In 2004, a community-based health insurance (CBI) scheme was introduced in Nouna district, Burkina Faso, with the primary objective of improving access to facility-based health services. In order to overcome self-selection issues in the analysis of the behavioral effects of insurance, we combine four waves of the Nouna Health District Household Survey into a panel data set, and use the randomized timing of insurance rollout to estimate the causal effect of insurance coverage on health-seeking behavior. While we find a generally positive association between CBI affiliation and treatment seeking, we cannot reject the null that the introduction of health insurance does not have any effect on treatment seeking in general, and utilization of facility-based professional care, in particular. Low levels of health care provider satisfaction, poor perceived quality of care by enrollees, and ambiguity in the coverage level of the CBI benefit package appear to have contributed to these weak results. Our findings imply that the basic notion of insurance mechanically increasing facility-based professional care is not necessarily true empirically, and likely contingent on a large number of contextual factors affecting health-seeking behavior within households and communities.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 75 (2012)
    Issue (Month): 4 ()
    Pages: 595-603

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    Handle: RePEc:eee:socmed:v:75:y:2012:i:4:p:595-603

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    Related research

    Keywords: Health-seeking behavior; Health insurance; Behavioral change; Moral hazard; Burkina Faso;

    References

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    2. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
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    Cited by:
    1. Aboud, Frances E. & Singla, Daisy R., 2012. "Challenges to changing health behaviours in developing countries: A critical overview," Social Science & Medicine, Elsevier, vol. 75(4), pages 589-594.
    2. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    3. Panda, P. & Chakraborty, A. & Dror, D.M. & Bedi, A.S., 2013. "Enrollment in community based health insurance schemes in rural Bihar and Uttar Pradesh, India," ISS Working Papers - General Series 555, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.

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