Social Insurance Programs
Brandon Williams
Development Economics
November 14, 2024
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
Nobody knew that health care could be so complicated."
--Donald Trump, 45th and 47th President of the United States
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Countries that are interested in providing health care for citizens typically do it in one of two ways:
- Single-payer-like: universal coverage funded through taxes
- Very expensive
- Contributory with a mandate: everyone must buy health insurance (either directly or in taxes), with subsidies
- How do you enforce the mandate when dealing with informal workers and poor populations?
- A toothless mandate = adverse selection
- Single-payer-like: universal coverage funded through taxes
- Evidenced in Indonesia: one year in less than 20% of target pop. had enrolled, comprised of more unhealthy individuals
- No direct mandate, but penalties to re-enroll
- Can enroll at any point in the year
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Three treatments informed by theory:
- Large, temporary subsidies
- At-home assistance with enrollment
- Information nudges
- Costs of a health episode
- Two week waiting period
- Legal requirement
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Three treatments informed by theory:
- Large, temporary subsidies - 18.6 pp ↑
- At-home assistance with enrollment
- Information nudges
- Costs of a health episode
- Two week waiting period
- Legal requirement
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Three treatments informed by theory:
- Large, temporary subsidies - 18.6 pp ↑
- At-home assistance with enrollment - 3.5 pp ↑
- Information nudges
- Costs of a health episode
- Two week waiting period
- Legal requirement
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Three treatments informed by theory:
- Large, temporary subsidies - 18.6 pp ↑
- At-home assistance with enrollment - 3.5 pp ↑
- Information nudges - ← →
- Costs of a health episode
- Two week waiting period
- Legal requirement
- Large, temporary subsidies - 18.6 pp ↑
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Three treatments informed by theory:
- Large, temporary subsidies - 18.6 pp ↑
- At-home assistance with enrollment - 3.5 pp ↑
- Information nudges - ← →
- Costs of a health episode
- Two week waiting period
- Legal requirement
- Many attempted to register but were unable to complete
- When offered subsidy and assistance, 55% of HH attempt to enroll, but less than half succeed
- Many wait until they are sick to enroll - adverse selection!
Low baseline enrollment
High returns to subsidy
Limited returns to registration
Some evidence of harvesting
No evidence of information effectiveness
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
Conditional on enrollment, subsidy HHs drop out more
HHs given subsidy stay in more often after subsidy lapses
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
Many want to enroll...
...but can't
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
Subsidy reduces adverse selection in total claims...
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
Subsidy reduces adverse selection in total claims...
...and cost of claims
Social Insurance Programs
Development Economics
November 14, 2024
Challenges of Universal Health Insurance (2021)
- Three treatments informed by theory:
- Large, temporary subsidies - 18.6 pp ↑
- At-home assistance with enrollment - 3.5 pp ↑
- Information nudges - ← →
- Costs of a health episode
- Two week waiting period
- Legal requirement
- Many attempted to register but were unable to complete
- When offered subsidy and assistance, 55% of HH attempt to enroll, but less than half succeed
- Many wait until they are sick to enroll - adverse selection!