Effects of Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme : A Cluster Randomized Trial
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World Bank, Washington, DC
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A cluster randomized controlled trial
was undertaken, testing two sets of interventions to
encourage enrollment in the Philippines' Individual
Payer Program. Of 243 municipalities, 179 were randomly
assigned as intervention sites and 64 as controls. In early
2011, 2,950 families were interviewed; unenrolled Individual
Payer Program-eligible families in intervention sites were
given an information kit and a 50 percent premium subsidy
until the end of 2011. In February 2012, the
"non-compliers" had their voucher extended, were
re-sent the enrollment kit, and received Short Message
Service (SMS) reminders. Half were told that in the upcoming
end-line interview the enumerator could help complete the
enrollment form, deliver it to the insurer, and have
identification cards mailed. The control and intervention
sites were balanced at baseline. In the control sites, 9.9
percent (32/323) of eligible individuals had enrolled by
January 2012, compared with 14.9 percent (119/801) in
intervention sites. In the sub-experiment, enrollment was
3.4 percent (10/290) among eligible non-compliers and who
did not receive assistance but 39.7 percent (124/312) among
those who did. A premium subsidy combined with information
can increase voluntary enrollment in a social health
insurance program, but less than an intervention that
reduces the enrollment burden; even that leaves enrollment
below 50 percent.
Palabras clave
ADVERSE SELECTION, COMMUNITIES, COST-EFFECTIVENESS, DEMAND FOR HEALTH, DEMAND FOR INSURANCE, ENROLLEES, FAIRS, FAMILIES, FAMILY INCOME, FINANCIAL PROTECTION, HEALTH CARE, HEALTH COVERAGE, HEALTH ECONOMICS, HEALTH FINANCING, HEALTH INSURANCE, HEALTH INSURANCE COVERAGE, HEALTH INSURANCE PROGRAM, HEALTH INSURANCE SCHEME, HEALTH INSURANCE SCHEMES, HEALTH ORGANIZATION, HEALTH POLICY, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEMS, HEALTH-CARE, HEALTH-FINANCING, HOUSEHOLD EXPENDITURE, HOUSEHOLDS, HUMAN DEVELOPMENT, INCOME COUNTRIES, INDIRECT COSTS, INFORMAL SECTOR, INFORMAL SECTOR WORKERS, INFORMATION PACK, INSURANCE COVERAGE, INSURANCE PREMIUM, INSURANCE PREMIUMS, INTERVENTION, INTERVENTIONS, LOCALITIES, MEDICAL PERSONNEL, NATIONAL HEALTH, NATIONAL HEALTH INSURANCE, PATIENT, PATIENTS, POCKET PAYMENTS, POLICY DISCUSSIONS, POLICY RESEARCH, PROBABILITY, PUBLIC HOSPITAL, QUALITY OF HEALTH, SOCIAL HEALTH INSURANCE, SOCIAL SCIENCE, SOCIAL SECURITY, SOCIAL SECURITY HEALTH INSURANCE, URBAN AREA, WORKERS