The Value of Health Insurance: A Field Experiment in India
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 11,089
- 主要终点
- Change in household health expenditure (inpatient and outpatient)
研究概览
简要总结
In this study, the investigators use a randomized field experiment in Karnataka, India, to measure the effects of a free inpatient public health insurance plan, Rashtriya Swasthya Bima Yojana (RSBY), on health and poverty. RSBY is India's first large-scale national public health insurance program, and was adopted in 2008 to cover below poverty line (BPL) households. This study examines the impact of expanding RSBY to cover above poverty line (APL) households that are not covered by RSBY or other secondary hospital care insurance plans. The study will examine the impact of a public insurance program on a range of health and economic outcomes to capture the full range of benefits from insurance. The goal of the study is to quantify how the RSBY program benefits health and reduces poverty. Differences in the outcomes between the treatment and control groups over the duration of the project will measure the causal effect of health insurance on health and financial outcomes. The investigators believe this will serve as a platform for the future of development of RSBY, and provide further insight into the effectiveness of health insurance in low-income countries.
详细描述
The study measures the impact of health insurance on healthcare utilization, health expenditures, nonmedical consumption, and financial behavior of participant households. The study consists of an evaluation involving households in two Indian districts of Karnataka - Mysore and Gulbarga. To measure the impact, households were randomized into one of three treatment groups and a control group that did not receive any intervention. Comparing households' health and financial status across the control and treatment groups will identify the impact of the RSBY coverage.
INNOVATIVE ASPECTS OF THE STUDY
The study has a number of innovative features that distinguish it from prior health insurance studies.
Spillovers from insurance: The study attempts to estimate the impact of financial and health spillovers from insurance. For example, formal health insurance may crowd out informal health insurance. The investigators study such spillovers by randomizing villages to different fractional allocations of households to study arms. Varying fractional allocations to each study group across villages allows them to randomly vary the fraction of households in each village that has insurance. This in turn yields different spillovers across villages that the investigators estimate using knowledge of the fractional allocation in each village.
Cognitive impacts of sickness and insurance: The investigators study the cognitive benefits of health insurance and better health. Recent research suggests that economic shocks, perhaps because they cause stress, reduce the cognitive capacity of individuals. This in turn leads to poor economic decision making and, perhaps, poverty traps. The investigators examine whether the same logic applies to health shocks and whether health insurance ameliorates negative cognitive effects associated with illness.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Participants must not already have access to the RSBY scheme or an equivalent state--run plan, or be already enrolled in a private insurance plan
- •Participating households must be located in Mysore or Gulbarga
排除标准
- •Households that do not speak Kannada (the local language in Karnataka)
研究组 & 干预措施
Group A
[Other: RSBY Health Insurance] The households in this group were offered RSBY for free. They did not have to pay the fee amount or premium amount and simply had to present their chit at the enrollment station and were enrolled. The entire premium amount including fee (Rs. 173 in Mysore, Rs. 163 in Gulbarga) has to be borne by the study. These households were automatically re-enrolled in RSBY for free for the second year of the study.
干预措施: RSBY Health Insurance (Other)
Group B
[Other: RSBY Health Insurance] The households in this treatment group were first given a cash transfer equivalent to the fee and premium for RSBY during the first visit to their household. In addition, they were offered the opportunity to purchase RSBY during a second visit to their household and get their household enrolled during that time. At that time, payment would be collected from the respondents who wanted to get enrolled and then these respondents would be taken to the enrollment stations to get them enrolled. For those households that chose to purchase RSBY for the first year of the study, their coverage was automatically extended to the second year of the study at no additional cost to them.
干预措施: RSBY Health Insurance (Other)
Group C
[Other: RSBY Health Insurance] The households in this group were simply offered an opportunity to purchase RSBY if they wished to. They were informed about this during the first visit to their household and for the households who wanted to get enrolled, the fee and premuim amount was collected and enrolment was done during the second visit to their household.
干预措施: RSBY Health Insurance (Other)
Group D
[No intervention] The households in this group were not offered anything and were informed that they had been randomly selected to not receive anything beyond the participation incentive that all survey participants received. In addition, a short survey was administered to them at this time.
结局指标
主要结局
Change in household health expenditure (inpatient and outpatient)
时间窗: up to 53 months
As assessed by questionnaire responses
次要结局
- Change in knowledge of/attitude towards the health care system and facilities(up to 53 months)
- Change in cognitive capacity(up to 53 months)
- Change in health status(up to 53 months)
- Change in productive and nonproductive assets(up to 53 months)
- Change in inpatient treatment(up to 53 months)
- Change in nonmedical consumption(up to 53 months)
- Change in income(up to 53 months)
- Change in employment status(up to 53 months)
- Change in health care utilization(up to 53 months)
- Change in borrowing and savings(up to 53 months)