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The Demand for Health Insurance in a Poor Economy: Evidence from Burkina Faso

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  • Schleicher, Michael
  • Klonner, Stefan
  • Sauerborn, Rainer
  • Sié, Alie
  • Souares, Aurélia

Abstract

We investigate the properties of health insurance demand in Burkina Faso, where we offered poor households a voluntary health insurance product at half the usual price. The targeting procedure we implemented delivers a fuzzy regression discontinuity design, which identifies the price elasticity of demand for health insurance as well as associated selection effects. We find large price elasticities among urban households, whereas the demand of rural households is price-inelastic. There are important selection effects, with widowed male household heads being most price-sensitive. Correlating these heterogeneous effects with survey data on informal transfers and health expenditures, our results suggest that informal risk-sharing largely crowds out formal insurance and that a single insurance product may fail to align with poor households' small health budgets. We find no adverse selection into health insurance.

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  • Schleicher, Michael & Klonner, Stefan & Sauerborn, Rainer & Sié, Alie & Souares, Aurélia, 2018. "The Demand for Health Insurance in a Poor Economy: Evidence from Burkina Faso," Working Papers 0648, University of Heidelberg, Department of Economics.
  • Handle: RePEc:awi:wpaper:0648
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    1. Martin Ravallion & Gaurav Datt & Dominique van de Walle, 1991. "Quantifying Absolute Poverty In The Developing World," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 37(4), pages 345-361, December.
    2. Dean Karlan & Robert Osei & Isaac Osei-Akoto & Christopher Udry, 2014. "Agricultural Decisions after Relaxing Credit and Risk Constraints," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 129(2), pages 597-652.
    3. Townsend, Robert M, 1994. "Risk and Insurance in Village India," Econometrica, Econometric Society, vol. 62(3), pages 539-591, May.
    4. Charles F. Manski, 1997. "Monotone Treatment Response," Econometrica, Econometric Society, vol. 65(6), pages 1311-1334, November.
    5. Joseph J. Capuno & Aleli D. Kraft & Stella Quimbo & Carlos R. Tan & Adam Wagstaff, 2016. "Effects of Price, Information, and Transactions Cost Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Randomized Experiment in the Philippines," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 650-662, June.
    6. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    7. Ethan Ligon & Jonathan P. Thomas & Tim Worrall, 2002. "Informal Insurance Arrangements with Limited Commitment: Theory and Evidence from Village Economies," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 69(1), pages 209-244.
    8. Sophie Mitra & Michael Palmer & Daniel Mont & Nora Groce, 2016. "Can Households Cope with Health Shocks in Vietnam?," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 888-907, July.
    9. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
    10. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust data-driven inference in the regression-discontinuity design," Stata Journal, StataCorp LP, vol. 14(4), pages 909-946, December.
    11. Shawn Cole & Xavier Gine & Jeremy Tobacman & Petia Topalova & Robert Townsend & James Vickery, 2013. "Barriers to Household Risk Management: Evidence from India," American Economic Journal: Applied Economics, American Economic Association, vol. 5(1), pages 104-135, January.
    12. Alma Cohen & Peter Siegelman, 2010. "Testing for Adverse Selection in Insurance Markets," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(1), pages 39-84, March.
    13. Precious Akampumuza & Hirotaka Matsuda, 2017. "Weather Shocks and Urban Livelihood Strategies: The Gender Dimension of Household Vulnerability in the Kumi District Of Uganda," Journal of Development Studies, Taylor & Francis Journals, vol. 53(6), pages 953-970, June.
    14. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust Nonparametric Confidence Intervals for Regression‐Discontinuity Designs," Econometrica, Econometric Society, vol. 82, pages 2295-2326, November.
    15. Wagstaff, Adam, 2007. "The economic consequences of health shocks: Evidence from Vietnam," Journal of Health Economics, Elsevier, vol. 26(1), pages 82-100, January.
    16. Schleicher, Michael & Souares, Aurélia & Pacere, Athanase Narangoro & Sauerborn, Rainer & Klonner, Stefan, 2016. "Decentralized versus Statistical Targeting of Anti-Poverty Programs: Evidence from Burkina Faso," Working Papers 0623, University of Heidelberg, Department of Economics.
    17. Marinho Bertanha & Guido W. Imbens, 2020. "External Validity in Fuzzy Regression Discontinuity Designs," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 38(3), pages 593-612, July.
    18. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    19. Vivi Alatas & Abhijit Banerjee & Rema Hanna & Benjamin A. Olken & Julia Tobias, 2012. "Targeting the Poor: Evidence from a Field Experiment in Indonesia," American Economic Review, American Economic Association, vol. 102(4), pages 1206-1240, June.
    20. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    21. Robertson, Laura & Mushati, Phyllis & Skovdal, Morten & Eaton, Jeffrey W. & Makoni, Jeremiah C. & Crea, Tom & Mavise, Gideon & Dumba, Lovemore & Schumacher, Christina & Sherr, Lorraine & Nyamukapa, Co, 2014. "Involving Communities in the Targeting of Cash Transfer Programs for Vulnerable Children: Opportunities and Challenges," World Development, Elsevier, vol. 54(C), pages 325-337.
    22. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, Oxford University Press, vol. 127(3), pages 1057-1106.
    23. Christopher Udry, 1994. "Risk and Insurance in a Rural Credit Market: An Empirical Investigation in Northern Nigeria," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 61(3), pages 495-526.
    24. Guido Imbens & Karthik Kalyanaraman, 2012. "Optimal Bandwidth Choice for the Regression Discontinuity Estimator," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 79(3), pages 933-959.
    25. 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.
    26. Sebastian Calonico & Matias D. Cattaneo & Rocío Titiunik, 2015. "Optimal Data-Driven Regression Discontinuity Plots," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 110(512), pages 1753-1769, December.
    27. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    28. Martin Eling & Shailee Pradhan & Joan T Schmit, 2014. "The Determinants of Microinsurance Demand," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 39(2), pages 224-263, April.
    29. Ahmed Mushfiq Mobarak & Mark R. Rosenzweig, 2013. "Informal Risk Sharing, Index Insurance, and Risk Taking in Developing Countries," American Economic Review, American Economic Association, vol. 103(3), pages 375-380, May.
    30. Basaza, Robert & Criel, Bart & Van der Stuyft, Patrick, 2008. "Community health insurance in Uganda: Why does enrolment remain low? A view from beneath," Health Policy, Elsevier, vol. 87(2), pages 172-184, August.
    31. Levine, David & Polimeni, Rachel & Ramage, Ian, 2016. "Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia," Journal of Development Economics, Elsevier, vol. 119(C), pages 1-15.
    32. Arnott, Richard & Stiglitz, Joseph E, 1991. "Moral Hazard and Nonmarket Institutions: Dysfunctional Crowding Out or Peer Monitoring?," American Economic Review, American Economic Association, vol. 81(1), pages 179-190, March.
    33. Adam Wagstaff & Ha Thi Hong Nguyen & Huyen Dao & Sarah Bales, 2016. "Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 663-674, June.
    34. AE Temu & JM Due, 2000. "Participatory appraisal approaches versus sample survey data collection: a case of smallholder farmers well-being ranking in Njombe District, Tanzania," Journal of African Economies, Centre for the Study of African Economies, vol. 9(1), pages 44-62.
    35. Dercon, Stefan & Hill, Ruth Vargas & Clarke, Daniel & Outes-Leon, Ingo & Seyoum Taffesse, Alemayehu, 2014. "Offering rainfall insurance to informal insurance groups: Evidence from a field experiment in Ethiopia," Journal of Development Economics, Elsevier, vol. 106(C), pages 132-143.
    36. Royalty, Anne Beeson & Hagens, John, 2005. "The effect of premiums on the decision to participate in health insurance and other fringe benefits offered by the employer: evidence from a real-world experiment," Journal of Health Economics, Elsevier, vol. 24(1), pages 95-112, January.
    37. Xavier Giné & Robert Townsend & James Vickery, 2008. "Patterns of Rainfall Insurance Participation in Rural India," The World Bank Economic Review, World Bank, vol. 22(3), pages 539-566, October.
    38. Valéry Ridde & Maurice Yaogo & Sylvie Zongo & Paul‐André Somé & Anne‐Marie Turcotte‐Tremblay, 2018. "Twelve months of implementation of health care performance‐based financing in Burkina Faso: A qualitative multiple case study," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(1), pages 153-167, January.
    39. Ravallion, Martin & Datt, Gaurav & van de Walle, Dominique, 1991. "Quantifying Absolute Poverty in the Developing World," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 37(4), pages 345-361, December.
    40. Sudhanshu Handa & Carolyn Huang & Nicola Hypher & Clarissa Teixeira & Fabio V. Soares & Benjamin Davis, 2012. "Targeting effectiveness of social cash transfer programmes in three African countries," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 4(1), pages 78-108, March.
    41. Gruber, Jonathan & Washington, Ebonya, 2005. "Subsidies to employee health insurance premiums and the health insurance market," Journal of Health Economics, Elsevier, vol. 24(2), pages 253-276, March.
    42. Temu, Andrew E & Due, Jean M, 2000. "Participatory Appraisal Approaches versus Sample Survey Data Collection: A Case of Smallholder Farmers Well-being Ranking in Njombe District, Tanzania," Journal of African Economies, Centre for the Study of African Economies, vol. 9(1), pages 44-62, March.
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