Social security health insurance for the informal sector in Nicaragua: a randomized evaluation.
Health Econ
; 19 Suppl: 181-206, 2010 Sep.
Article
en En
| MEDLINE
| ID: mdl-20593433
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Seguridad Social
/
Reforma de la Atención de Salud
/
Servicios de Salud
/
Accesibilidad a los Servicios de Salud
/
Seguro de Salud
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Qualitative_research
Aspecto:
Determinantes_sociais_saude
/
Equity_inequality
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America central
/
Nicaragua
Idioma:
En
Revista:
Health Econ
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2010
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Reino Unido