The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-scale Randomized Experiment in Indonesia

Rema Hanna and Benjamin Olken
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Rema Hanna: Center for International Development at Harvard University

No 362, CID Working Papers from Center for International Development at Harvard University

Abstract: To assess ways to achieve widespread health insurance coverage with financial solvency in developing countries, we designed a randomized experiment involving almost 6,000 households in Indonesia who are subject to a nationally mandated government health insurance program. We assessed several interventions that simple theory and prior evidence suggest could increase coverage and reduce adverse selection: substantial temporary price subsidies (which had to be activated within a limited time window and lasted for only a year), assisted registration, and information. Both temporary subsidies and assisted registration increased initial enrollment. Temporary subsidies attracted lower-cost enrollees, in part by eliminating the practice observed in the no subsidy group of strategically timing coverage for a few months during health emergencies. As a result, while subsidies were in effect, they increased coverage more than eightfold, at no higher unit cost; even after the subsidies ended, coverage remained twice as high, again at no higher unit cost. However, the most intensive (and effective) intervention – assisted registration and a full one-year subsidy – resulted in only a 30 percent initial enrollment rate, underscoring the challenges to achieving widespread coverage.

Keywords: Global; Health (search for similar items in EconPapers)
JEL-codes: I13 O15 (search for similar items in EconPapers)
Date: 2019-10
New Economics Papers: this item is included in nep-dev, nep-exp, nep-hea, nep-ias and nep-sea
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (5)

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https://growthlab.cid.harvard.edu/files/growthlab/ ... urance-indonesia.pdf (application/pdf)

Related works:
Working Paper: The challenges of universal health insurance in developing countries: Evidence from a large-scale randomized experiment in Indonesia (2020)
Working Paper: The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-scale Randomized Experiment in Indonesia (2019)
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