Encouraging Health Insurance for the Informal Sector : A Cluster Randomized Trial

Wagstaff, Adam ; Nguyen, Ha Thi Hong ; Dao, Huyen ; Bales, Sarah

World Bank, Washington, DC

关键词: ADVERSE SELECTION;    CHEMOTHERAPY;    COMMUNES;    COMMUNITIES;    COMMUNITY HEALTH;   

DOI  :  10.1596/1813-9450-6910
RP-ID  :  WPS6910

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Subsidized voluntary enrollment ingovernment-run health insurance schemes is often proposed asa way of increasing coverage among informal sector workersand their families. This paper reports the results of acluster randomized control trial in which 3,000 householdsin 20 communes in Vietnam were randomly assigned at baselineto a control group or one of three treatments: aninformation leaflet about Vietnam s government-run schemeand the benefits of health insurance; a voucher entitlingeligible household members to 25 percent off their annualpremium; and both. The four groups were balanced atbaseline. In the control group, 6.3 percent (82/1296) ofindividuals were enrolled in the endline, compared with 6.3percent (79/1257), 7.2 percent (96/1327), and 7.0 percent(87/1245) in the information, subsidy, and combinedintervention groups; the adjusted odds ratios were 0.94,1.12, and 1.15, respectively. Only among those reportingpoor health were any significant intervention effects found,and only for the combined intervention: an enrollment rateof 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 voluntaryhealth insurance enrollment through information campaignsand subsidies, and that these interventions exacerbateadverse selection.