Getting the Poor to Enroll in Health Insurance, and Its Effect on Utilization of Health Care and Health: Evidence from a Field Experiment in Ghana

Patrick Asuming, Columbia University

Many developing countries have recently instituted social health insurance schemes (SHIs) to ease financial barriers to utilization of healthcare services and help mitigate the effects of adverse health shocks. Although these SHIs offer generous terms and benefits, enrollment remains low especially among the poorest households who are the intended primary beneficiaries. This paper implements randomized interventions to understand the reasons for low enrollment and estimate the effects of insurance coverage on utilization of healthcare, financial protection and health. My results show that imperfect information, and insurance premium and fees affect enrollment. I find that insurance coverage leads to increased utilization of healthcare services, reduced out-of-pocket payments among individuals with prior positive expenses and improvement in health outcomes. My results suggest strong complementarities between providing information and providing subsidies in utilization and health outcomes, an indication of the importance of the combined interventions for achieving changes in health-seeking behavior and outcomes.