Formal Insurance and the Dynamics of Social Capital: Experimental Evidence from Uganda

Cecchi, Francesco; Duchoslav, Jan; Bulte, Erwin

doi:10.1093/jae/ejw002

Cited by 27 publications

(18 citation statements)

References 33 publications

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“…Biggeri et al 14 study the feasibility of CBHI in a region without prior experience in a willingness to pay exercise. Cecchi et al, 15 using a public good experiment, study the dynamics of social capital when third-party – run CBHI is introduced in villages. They reveal that social capital suffers when insurance is formalised through CBHI schemes.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

Nshakira‐Rukundo

Mussa

Nshakira

et al. 2019

Int J Health Policy Manag

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Background: The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households’ decisions to enrol and renew membership in these schemes. Methods: We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. Results: Results revealed that household’s socioeconomic status, husband’s employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. Conclusion: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

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Section: Introductionmentioning

confidence: 99%

“…37 While previous studies have shown a low demand for CBHI in Uganda, 11,12 recent studies have shown increasing interest. 14,15 It is understood that in the financial year 2018/2019, the revised National Health Insurance Bill will be approved into law for the establishment of a national health insurance scheme. 38…”

Section: Introductionmentioning

confidence: 99%

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

Nshakira‐Rukundo

Mussa

Nshakira

et al. 2019

Int J Health Policy Manag

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“…Cecchi, Duchoslav, and Bulte () use a somewhat similar method; they do not explore double differences, but they assess the impact of health insurance on public good contributions by comparing (predicted) adopters and non‐adopters across villages with and without access to health insurance.…”

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confidence: 99%

Effects of Index Insurance on Demand and Supply of Credit: Evidence from Ethiopia

Belissa¹,

Lensink²,

Winkel³

2020

American J Agri Economics

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Index‐based insurance offers a climate risk management strategy that can benefit the poor. This article focuses on whether adopting index insurance improves access to financial markets and reduces credit rationing, using empirical analyses focused on Ethiopia. With different identification strategies, including a newly developed method that leverages the varying availability of index insurance across areas, the authors control for potential selection biases by forecasting potential insurance adopters; they apply a cross‐sectional double‐difference method. Credit rationing can take the form of either supply‐side quantity rationing, in which case potential borrowers who need credit are involuntarily excluded from the credit market, or demand‐side rationing, such that borrowers self‐select and voluntarily withdraw to avoid transaction costs and threats to their collateral. By differentiating supply‐side and demand‐side forms and employing a direct elicitation method to determine credit rationing status, this study reveals that 38% of sample households are credit constrained. The preferred estimation techniques suggest that index insurance significantly reduces supply‐side rationing.

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“…Contrariwise, other studies, mainly focusing broadly on social capital, have suggested that reciprocal support within social networks may facilitate insurance uptake by enabling individuals to afford the financial cost of scheme membership . Most studies are based on the reverse impact of formal health insurance on informal support, with the majority reporting a negative effect . Ligon et al explained that because formal health insurance provides an alternative protection against illness, it tends to reduce the social costs associated with nonparticipation in informal social protection systems.…”

Section: Introductionmentioning

confidence: 99%

Effect of informal financial support for health care on health Insurance uptake: Evidence from a mixed‐methods study in Tamale metropolis of northern Ghana

Alhassan

2018

Health Planning & Management

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Attempts to study the determinants of health insurance enrollment in resource-poor settings have often given less consideration to the potential influence of informal risk-sharing systems on individuals and households' decisions about health insurance. This paper contributes to existing discussions in this area by examining the effect of informal financial support for health care, an example of informal risk-sharing arrangement, on enrollment in the Ghana National Health Insurance Scheme (NHIS). It is based on a mixed-methods research in Tamale metropolis of northern Ghana. The study found widespread availability and reliance on informal support among low-income households to finance out-of-pocket health-care expenditure. Informal financial support for enrollment into the NHIS was noted to be less available. The study further found less strong but suggestive evidence that the perceived availability of informal financial support for health care by individuals diminishes their enrollment in the NHIS. The paper emphasizes the need for theory and policy on health insurance uptake in resource-constrained settings to consider existing informal risk-sharing arrangements as much as other known determinants of enrollment.

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Formal Insurance and the Dynamics of Social Capital: Experimental Evidence from Uganda

Cited by 27 publications

References 33 publications

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

Effects of Index Insurance on Demand and Supply of Credit: Evidence from Ethiopia

Effect of informal financial support for health care on health Insurance uptake: Evidence from a mixed‐methods study in Tamale metropolis of northern Ghana

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