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The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review

Author

Listed:
  • Acharya, Arnab
  • Vellakkal, Sukumar
  • Taylor Fiona
  • Masset Edoardo
  • Satija, Ambika
  • Burke, Margaret
  • Ebrahim, Shah

Abstract

This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. The authors summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. They find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases, however, the impact on the poor is weaker. More information is needed to understand the reasons for low enrollment and to explain the limited impact of health insurance among the insured.

Suggested Citation

  • Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
  • Handle: RePEc:wbk:wbrwps:6324
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    References listed on IDEAS

    as
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    Cited by:

    1. Bernal Lobato, N., 2014. "Essays in applied microeconomics," Other publications TiSEM 9b638b3d-2f83-452a-b2c8-c, Tilburg University, School of Economics and Management.
    2. repec:eee:pubeco:v:154:y:2017:i:c:p:122-136 is not listed on IDEAS
    3. Asuming, Patrick Opoku & Kim, Hyuncheol Bryant & Sim, Armand, 2017. "Long-Run Consequences of Health Insurance Promotion: Evidence from a Field Experiment in Ghana," IZA Discussion Papers 11117, Institute for the Study of Labor (IZA).
    4. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, pages 122-136.
    5. Gajate-Garrido, Gissele & Ahiadeke, Clement, 2015. "The effect of insurance enrollment on maternal and child health care utilization: The case of Ghana," IFPRI discussion papers 1495, International Food Policy Research Institute (IFPRI).
    6. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, pages 122-136.
    7. 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.

    More about this item

    Keywords

    Health Monitoring&Evaluation; Health Systems Development&Reform; Health Economics&Finance; Health Law; Insurance&Risk Mitigation;

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