Social security health insurance for the informal sector in Nicaragua: A randomized evaluation

Rebecca L. Thornton, Laurel E. Hatt, Erica M. Field, Mursaleena Islam, Freddy Sols Diaz, Martha Azucena González

Research output: Contribution to journalReview articlepeer-review

Abstract

This article presents the results from an experimental evaluation of a voluntary health insurance program for informal sector workers in Nicaragua. Costs of the premiums as well as enrollment location were randomly allocated. Overall, take-up of the program was low, with only 20% enrollment. Program costs and streamlined bureaucratic procedures were important determinants of enrollment. Participation of local microfinance institutions had a slight negative effect on enrollment. One year later, those who received insurance substituted toward services at covered facilities and total out-of-pocket expenditures fell. However, total expenditures fell by less than the insurance premiums. We find no evidence of an increase in health-care utilization among the newly insured. We also find very low retention rates after the expiration of the subsidy, with less than 10% of enrollees still enrolled after one year. To shed light on the findings from the experimental results, we present qualitative evidence of institutional and contextual factors that limited the success of this program.

Original languageEnglish (US)
Pages (from-to)181-206
Number of pages26
JournalHealth Economics
Volume19
Issue numberSUPPL. 1
DOIs
StatePublished - Sep 2010
Externally publishedYes

Keywords

  • Nicaragua
  • health insurance
  • microfinance institutions
  • randomized experiment

ASJC Scopus subject areas

  • Health Policy

Fingerprint Dive into the research topics of 'Social security health insurance for the informal sector in Nicaragua: A randomized evaluation'. Together they form a unique fingerprint.

Cite this