IDEAS home Printed from https://ideas.repec.org/a/eee/wdevel/v104y2018icp212-221.html
   My bibliography  Save this article

Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana

Author

Listed:
  • Strupat, Christoph
  • Klohn, Florian

Abstract

This paper delivers empirical evidence on how transfers that serve as an informal insurance mechanism are affected by a formal and country-wide health insurance scheme. Using the fifth and fourth waves of the Ghanaian Living Standard Household Survey, we investigate the extent to which the implementation of the National Health Insurance Scheme affects health-related outcomes and making or receiving informal transfers. Our findings suggest that there is a reduction of out-of-pocket expenditures for health services and a significant crowding out of informal transfers. We conclude that the provision of formal health insurance does not only relieve ill individuals from out-of-pocket expenditures, but also their network partners from making informal transfers.

Suggested Citation

  • Strupat, Christoph & Klohn, Florian, 2018. "Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana," World Development, Elsevier, vol. 104(C), pages 212-221.
    • Handle: RePEc:eee:wdevel:v:104:y:2018:i:c:p:212-221
    DOI: 10.1016/j.worlddev.2017.11.004
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0305750X17303662
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.worlddev.2017.11.004?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
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Wahhaj, Zaki, 2010. "Social norms and individual savings in the context of informal insurance," Journal of Economic Behavior & Organization, Elsevier, vol. 76(3), pages 511-530, December.
    2. repec:hal:spmain:info:hdl:2441/14otokka698nb83lk2n7bhqbo2 is not listed on IDEAS
    3. Powell-Jackson, Timothy & Hanson, Kara & Whitty, Christopher J.M. & Ansah, Evelyn K., 2014. "Who benefits from free healthcare? Evidence from a randomized experiment in Ghana," Journal of Development Economics, Elsevier, vol. 107(C), pages 305-319.
    4. Ligon, Ethan & Schechter, Laura, 2012. "Motives for sharing in social networks," Journal of Development Economics, Elsevier, vol. 99(1), pages 13-26.
    5. Margherita Comola & Marcel Fafchamps, 2017. "The Missing Transfers: Estimating Misreporting in Dyadic Data," Economic Development and Cultural Change, University of Chicago Press, vol. 65(3), pages 549-582.
    6. Townsend, Robert M, 1994. "Risk and Insurance in Village India," Econometrica, Econometric Society, vol. 62(3), pages 539-591, May.
    7. Stephen Leider & Markus M. Möbius & Tanya Rosenblat & Quoc-Anh Do, 2009. "Directed Altruism and Enforced Reciprocity in Social Networks," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(4), pages 1815-1851.
    8. Pamela Jakiela & Owen Ozier, 2016. "Does Africa Need a Rotten Kin Theorem? Experimental Evidence from Village Economies," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 83(1), pages 231-268.
    9. Nermin Oruč, 2011. "Do Social Transfers "Crowd-Out" Remittances: Evidence from Bosnia," wiiw Balkan Observatory Working Papers 92, The Vienna Institute for International Economic Studies, wiiw.
    10. Shigute, Zemzem & Strupat, Christoph & Burchi, Francesco & Alemu, Getnet & Bedi, Arjun S., 2017. "The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia," IZA Discussion Papers 10939, Institute of Labor Economics (IZA).
    11. Ambler, Kate, 2015. "Don't tell on me: Experimental evidence of asymmetric information in transnational households," Journal of Development Economics, Elsevier, vol. 113(C), pages 52-69.
    12. Stefan Dercon & Pramila Krishnan, 2003. "Risk Sharing and Public Transfers," Economic Journal, Royal Economic Society, vol. 113(486), pages 86-94, March.
    13. Udry, Christopher R. & Conley, Timothy G., 2004. "Social Networks in Ghana," Center Discussion Papers 28488, Yale University, Economic Growth Center.
    14. Marina Pavan & Aldo Colussi, 2008. "Assessing the Impact of Public Transfers on Private Risk Sharing Arrangements. Evidence from a Randomized Experiment in Mexico," Working Papers 200807, Geary Institute, University College Dublin.
    15. Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2010. "Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 95-106, September.
    16. Attanasio, Orazio & Rios-Rull, Jose-Victor, 2000. "Consumption smoothing in island economies: Can public insurance reduce welfare?," European Economic Review, Elsevier, vol. 44(7), pages 1225-1258, June.
    17. Esther Duflo & Michael Kremer & Jonathan Robinson, 2011. "Nudging Farmers to Use Fertilizer: Theory and Experimental Evidence from Kenya," American Economic Review, American Economic Association, vol. 101(6), pages 2350-2390, October.
    18. Lasse Brune & Xavier Giné & Jessica Goldberg & Dean Yang, 2016. "Facilitating Savings for Agriculture: Field Experimental Evidence from Malawi," Economic Development and Cultural Change, University of Chicago Press, vol. 64(2), pages 187-220.
    19. Salvatore di Falco & Erwin Bulte, 2011. "A Dark Side of Social Capital? Kinship, Consumption, and Savings," Journal of Development Studies, Taylor & Francis Journals, vol. 47(8), pages 1128-1151, June.
    20. Lenel, Friederike & Steiner, Susan, 2017. "Insurance and Solidarity: Evidence from a Lab-in-the-Field Experiment in Cambodia," IZA Discussion Papers 10986, Institute of Labor Economics (IZA).
    21. Nava Ashraf, 2009. "Spousal Control and Intra-household Decision Making: An Experimental Study in the Philippines," American Economic Review, American Economic Association, vol. 99(4), pages 1245-1277, September.
    22. Lin, Wanchuan & Liu, Yiming & Meng, Juanjuan, 2014. "The crowding-out effect of formal insurance on informal risk sharing: An experimental study," Games and Economic Behavior, Elsevier, vol. 86(C), pages 184-211.
    23. Landmann, Andreas & Vollan, Björn & Frölich, Markus, 2012. "Insurance versus Savings for the Poor: Why One Should Offer Either Both or None," IZA Discussion Papers 6298, Institute of Labor Economics (IZA).
    24. Francesco Cecchi & Jan Duchoslav & Erwin Bulte, 2016. "Formal Insurance and the Dynamics of Social Capital: Experimental Evidence from Uganda," Journal of African Economies, Centre for the Study of African Economies, vol. 25(3), pages 418-438.
    25. Morduch, Jonathan, 1999. "Between the State and the Market: Can Informal Insurance Patch the Safety Net?," The World Bank Research Observer, World Bank, vol. 14(2), pages 187-207, August.
    26. Lenel, Friederike & Steiner, Susan, 2016. "Insurance and Solidarity," VfS Annual Conference 2016 (Augsburg): Demographic Change 145898, Verein für Socialpolitik / German Economic Association.
    27. Hoff, Karla & Sen, Arijit, 2005. "The kin system as a poverty trap?," Policy Research Working Paper Series 3575, The World Bank.
    Full references (including those not matched with items on IDEAS)

    Citations

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


    Cited by:

    1. David K Evans & Katrina Kosec, 2023. "Cash Transfers, Trust, and Inter-household Transfers: Experimental Evidence from Tanzania," The World Bank Economic Review, World Bank, vol. 37(2), pages 221-234.
    2. Nikolov, Plamen & Bonci, Matthew, 2020. "Do public program benefits crowd out private transfers in developing countries? A critical review of recent evidence," World Development, Elsevier, vol. 134(C).
    3. Heath Henderson & Arnob Alam, 2022. "The structure of risk-sharing networks," Empirical Economics, Springer, vol. 62(2), pages 853-886, February.
    4. Hample, Kelsey C, 2021. "Formal insurance for the informally insured: Experimental evidence from Kenya," World Development Perspectives, Elsevier, vol. 22(C).
    5. Strupat, Christoph, 2021. "The preserving effect of social protection on social cohesion during the COVID-19 pandemic: Evidence from Kenya," IDOS Discussion Papers 33/2021, German Institute of Development and Sustainability (IDOS), revised 2021.
    6. Afriyie-Kraft, Lydia & Zabel, Astrid & Damnyag, Lawrence, 2020. "Adaptation strategies of Ghanaian cocoa farmers under a changing climate," Forest Policy and Economics, Elsevier, vol. 113(C).
    7. Keetie Roelen & Carmen Leon-Himmelstine & Sung Kyu Kim, 2022. "Chicken or Egg? A Bi-directional Analysis of Social Protection and Social Cohesion in Burundi and Haiti," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 34(3), pages 1216-1239, June.
    8. Will, Meike & Groeneveld, Jürgen & Lenel, Friederike & Frank, Karin & Müller, Birgit, 2023. "Determinants of Household Vulnerability in Networks with Formal Insurance and Informal Risk-Sharing," Ecological Economics, Elsevier, vol. 212(C).
    9. Lenel, Friederike & Steiner, Susan, 2020. "Formal insurance and solidarity. Experimental evidence from Cambodia," Journal of Economic Behavior & Organization, Elsevier, vol. 174(C), pages 212-234.
    10. Grimm, Michael & Hartwig, Renate & Reitmann, Ann-Kristin & Bocoum, Fadima Yaya, 2020. "Can informal redistribution withstand formal safety nets? Insights from urban-rural transfers in Burkina Faso," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-81-20, University of Passau, Faculty of Business and Economics.
    11. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    12. Strupat, Christoph, 2021. "The preserving effect of social protection on social cohesion during the COVID-19 pandemic: Evidence from Kenya," MPRA Paper 111501, University Library of Munich, Germany.
    13. Meike Will & Jürgen Groeneveld & Karin Frank & Birgit Müller, 2021. "Informal risk-sharing between smallholders may be threatened by formal insurance: Lessons from a stylized agent-based model," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-18, March.
    14. Strupat, Christoph & Farfán, Gabriela & Moritz, Laura & Negre, Mario & Vakis, Renos, 2021. "Obesity and food away from home: What drives the socioeconomic gradient in excess body weight?," Economics & Human Biology, Elsevier, vol. 43(C).
    15. Grimm, Michael & Hartwig, Renate & Reitmann, Ann-Kristin & Bocoum, Fadima Yaya, 2021. "Inter-household transfers: An empirical investigation of the income-transfer relationship with novel data from Burkina Faso," World Development, Elsevier, vol. 144(C).
    16. Sandra Pellet & Marine De Talancé, 2023. "Labor Migrants at Risk: Formal and Informal Insurance Strategies among Central Asians in Moscow [Migrantes laborales en riesgo: estrategias de seguro formales e informales entre los centroasiáticos," Post-Print hal-04261417, HAL.
    17. Garcia-Mandicó, Sílvia & Reichert, Arndt & Strupat, Christoph, 2021. "The Social Value of Health Insurance: Results from Ghana," Journal of Public Economics, Elsevier, vol. 194(C).
    18. Nigus, Halefom & Nillesen, Eleonora & Mohnen, Pierre, 2018. "The effect of weather index insurance on social capital: Experimental evidence from Ethiopia," MERIT Working Papers 2018-007, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    19. Geng, Xin & Janssens, Wendy & Kramer, Berber & van der List, Marijn, 2018. "Health insurance, a friend in need? Impacts of formal insurance and crowding out of informal insurance," World Development, Elsevier, vol. 111(C), pages 196-210.
    20. Christoph Strupat, 2022. "Social Protection and Social Cohesion in Times of the COVID-19 Pandemic: Evidence from Kenya," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 34(3), pages 1320-1357, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Klohn, Florian & Strupat, Christoph, 2013. "Crowding out of Solidarity? – Public Health Insurance versus Informal Transfer Networks in Ghana," Ruhr Economic Papers 432, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    2. Florian Klohn & Christoph Strupat, 2013. "Crowding out of Solidarity? – Public Health Insurance versus Informal Transfer Networks in Ghana," Ruhr Economic Papers 0432, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    3. repec:zbw:rwirep:0432 is not listed on IDEAS
    4. Grimm, Michael & Hartwig, Renate & Reitmann, Ann-Kristin & Bocoum, Fadima Yaya, 2021. "Inter-household transfers: An empirical investigation of the income-transfer relationship with novel data from Burkina Faso," World Development, Elsevier, vol. 144(C).
    5. Nigus, Halefom & Nillesen, Eleonora & Mohnen, Pierre, 2018. "The effect of weather index insurance on social capital: Experimental evidence from Ethiopia," MERIT Working Papers 2018-007, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    6. Nikolov, Plamen & Bonci, Matthew, 2020. "Do public program benefits crowd out private transfers in developing countries? A critical review of recent evidence," World Development, Elsevier, vol. 134(C).
    7. Strobl, Renate & Wunsch, Conny, 2017. "Does Voluntary Risk Taking Affect Solidarity? Experimental Evidence from Kenya," Working papers 2017/12, Faculty of Business and Economics - University of Basel.
    8. Landmann, Andreas & Vollan, Björn & Henning, Karla & Frölich, Markus, 2020. "Crowding-Out or Crowding-In? Heterogeneous Effects of Insurance on Solidarity," IZA Discussion Papers 13688, Institute of Labor Economics (IZA).
    9. Ethan Ligon & Laura Schechter, 2020. "Structural Experimentation to Distinguish between Models of Risk Sharing with Frictions in Rural Paraguay," Economic Development and Cultural Change, University of Chicago Press, vol. 69(1), pages 1-50.
    10. Strobl, Renate & Wunsch, Conny, 2018. "Risky Choices and Solidarity: Why Experimental Design Matters," Working papers 2018/17, Faculty of Business and Economics - University of Basel.
    11. Joachim De Weerdt & Kalle Hirvonen, 2016. "Risk Sharing and Internal Migration," Economic Development and Cultural Change, University of Chicago Press, vol. 65(1), pages 63-86.
    12. Di Falco, Salvatore & Feri, Francesco & Pin, Paolo & Vollenweider, Xavier, 2018. "Ties that bind: Network redistributive pressure and economic decisions in village economies," Journal of Development Economics, Elsevier, vol. 131(C), pages 123-131.
    13. Ambler, Kate, 2015. "Don't tell on me: Experimental evidence of asymmetric information in transnational households," Journal of Development Economics, Elsevier, vol. 113(C), pages 52-69.
    14. Batista, Catia & Silverman, Dan & Yang, Dean, 2015. "Directed giving: Evidence from an inter-household transfer experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 118(C), pages 2-21.
    15. Grimm, Michael & Hartwig, Renate & Lay, Jann, 2017. "Does forced solidarity hamper investment in small and micro enterprises?," Journal of Comparative Economics, Elsevier, vol. 45(4), pages 827-846.
    16. Ingela Alger & Laura Juarez & Miriam Juarez-Torres & Josepa Miquel-Florensa, 2020. "Do Informal Transfers Induce Lower Efforts? Evidence from Lab-in-the-Field Experiments in Rural Mexico," Economic Development and Cultural Change, University of Chicago Press, vol. 69(1), pages 107-171.
    17. Bartoš, Vojtěch, 2021. "Seasonal scarcity and sharing norms," Journal of Economic Behavior & Organization, Elsevier, vol. 185(C), pages 303-316.
    18. Lin, Wanchuan & Meng, Juanjuan & Weng, Xi, 2020. "Formal insurance and informal risk sharing dynamics," Journal of Economic Behavior & Organization, Elsevier, vol. 180(C), pages 837-863.
    19. Pamela Jakiela & Owen Ozier, 2016. "Does Africa Need a Rotten Kin Theorem? Experimental Evidence from Village Economies," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 83(1), pages 231-268.
    20. Dean Karlan & Aishwarya Lakshmi Ratan & Jonathan Zinman, 2014. "Savings by and for the Poor: A Research Review and Agenda," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 60(1), pages 36-78, March.
    21. Pascaline Dupas & Anthony Keats & Jonathan Robinson, 2019. "The Effect of Savings Accounts on Interpersonal Financial Relationships: Evidence from a Field Experiment in Rural Kenya," The Economic Journal, Royal Economic Society, vol. 129(617), pages 273-310.

    More about this item

    Keywords

    Public health insurance; Informal transfer networks crowding out; Ghana;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

    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:eee:wdevel:v:104:y:2018:i:c:p:212-221. 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.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with 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: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/worlddev .

    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.