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Encouraging health insurance for the informal sector : a cluster randomized trial

Author

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  • Wagstaff, Adam
  • Nguyen, Ha Thi Hong
  • Dao, Huyen
  • Balesd, Sarah

Abstract

Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. This paper reports the results of a cluster randomized control trial in which 3,000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam’s government-run scheme and the benefits of health insurance; a voucher entitling eligible household members to 25 percent off their annual premium; and both. The four groups were balanced at baseline. In the control group, 6.3 percent (82/1296) of individuals were enrolled in the endline, compared with 6.3 percent (79/1257), 7.2 percent (96/1327), and 7.0 percent (87/1245) in the information, subsidy, and combined intervention groups; the adjusted odds ratios were 0.94, 1.12, and 1.15, respectively. Only among those reporting poor health were any significant intervention effects found, and only for the combined intervention: an enrollment rate of 16.3 percent (33/202) compared with 8.3 percent (18/218) in the control group, and an adjusted odds ratio of 2.50. The results suggest limited opportunities to raise voluntary health insurance enrollment through information campaigns and subsidies, and that these interventions exacerbate adverse selection.

Suggested Citation

  • Wagstaff, Adam & Nguyen, Ha Thi Hong & Dao, Huyen & Balesd, Sarah, 2014. "Encouraging health insurance for the informal sector : a cluster randomized trial," Policy Research Working Paper Series 6910, The World Bank.
  • Handle: RePEc:wbk:wbrwps:6910
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    2. Mohammed Elhaj Mustafa & Ebaidalla Mahjoub Ebaidalla, 2019. "Factors Influencing Informal Workers’ Participation in Health Insurance in Sudan: Evidence from Khartoum and Kassala States," Working Papers 1300, Economic Research Forum, revised 2019.
    3. Bredenkamp, Caryn & Evans, Timothy & Lagrada, Leizel & Langenbrunner, John & Nachuk, Stefan & Palu, Toomas, 2015. "Emerging challenges in implementing universal health coverage in Asia," Social Science & Medicine, Elsevier, vol. 145(C), pages 243-248.

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    Keywords

    Health Monitoring&Evaluation; Health Economics&Finance; Health Systems Development&Reform; Health Law; Housing&Human Habitats;
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