The Value of Health Insurance: A Field Experiment in India

NCT03144076 | Completed

• 1 other identifier: IRB12-2085
• Study Type: interventional
• Target: 11,089
• Locations: 0 countries
• Sites: N/A

Brief Summary

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.

Conditions

Health Expenditure

Keywords

healthcare; India; health insurance; RSBY; free health insurance; inpatient insurance; wealth transfer

Outcome Measures

Primary Outcomes (1)

• Change in household health expenditure (inpatient and outpatient)

  As assessed by questionnaire responses

  up to 53 months

Secondary Outcomes (10)

• Change in inpatient treatment

  up to 53 months

• Change in cognitive capacity

  up to 53 months

• Change in employment status

  up to 53 months

• Change in health care utilization

  up to 53 months

• Change in health status

  up to 53 months

Study Arms (4)

Group A

EXPERIMENTAL

\[Other: RSBY Health Insurance\] 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.

Other: RSBY Health Insurance

Group B

EXPERIMENTAL

\[Other: RSBY Health Insurance\] 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.

Other: RSBY Health Insurance

Group C

EXPERIMENTAL

\[Other: RSBY Health Insurance\] 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.

Other: RSBY Health Insurance

Group D

NO INTERVENTION

\[No intervention\] 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.

Interventions

RSBY Health Insurance OTHER

RSBY is a national inpatient public insurance plan in India, made available through this study to participants in Groups A, B, and C.

Group A; Group B; Group C

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• Households that do not speak Kannada (the local language in Karnataka)

Sponsors & Collaborators

• University of Chicago: lead
• Public Health Foundation of India: collaborator
• Northwestern University: collaborator

Study Officials

• Anup Malani, PhD

  University of Chicago

  PRINCIPAL INVESTIGATOR

• Cynthia Kinnan, PhD

  Northwestern University

  PRINCIPAL INVESTIGATOR

• Alessandra Voena, PhD

  University of Chicago

  PRINCIPAL INVESTIGATOR

• Gabriella Conti, PhD

  University College, London

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 8, 2017
• First Posted: May 8, 2017
• Study Start: September 1, 2013
• Primary Completion: May 1, 2017
• Study Completion: May 1, 2017
• Last Updated: July 1, 2019

Record last verified: 2018-02

Data Sharing

• IPD Sharing: Will not share