Versicherung und Hilfeleistungen zwischen Privathaushalten - Eine experimentelle Untersuchung
Zusammenfassung der Projektergebnisse
Given the dearth of insurance markets in developing countries, many governments, the private sector and the donor community made considerable efforts over the last years to design appropriate insurance products and to expand people's coverage with formal insurance. This project contributed to a better understanding of the consequences for informal support, i.e. monetary transfers provided by relatives, neighbours and friends, when insurance is introduced. If insurance crowds out informal support and delivers only incomplete risk coverage (for example, because not everybody gets insured, insurance does not fully compensate losses, or not all risks are insurable), introducing insurance does not necessarily lead to welfare improvements. A clear understanding of the conditions under which crowding out occurs is thus necessary to help design insurance contracts that avoid such unintended consequences. We conducted a lab-in-the-field experiment with villagers in Cambodia. Villagers were randomly assigned the role of provider or recipient. Each provider was anonymously matched with one recipient. Both received the same endowment. The recipient could lose a large proportion of her endowment due to a random shock (simulated by the roll of a die). We varied whether the recipient had the option to purchase insurance which avoided the loss from the shock. The provider was asked how much of her endowment she would transfer to the recipient in case the recipient loses. Transfers were only enacted if the recipient experienced the shock. Our interest was to see whether providers made a difference between recipients who had an option to get insured but did not use this option and recipients who had no option of insurance. We find that providers were willing to transfer one third less to recipients with the insurance option compared with what they were willing to transfer to recipients without the insurance option. This finding indicates that informal support is crowded out when insurance becomes available as villagers expect each other to take up insurance. Those who do not take up insurance receive less informal support; they seem to be held accountable when faced with an emergency. Our result is important for the design of insurance policies in Cambodia and beyond. Cambodia has a very high ratio of out-of-pocket health expenditures to total health expenses (74% in 2014). Such a high ratio is of great concern because people with few resources often delay or forgo critical health treatment or revert to depletion of their assets (e.g. sale of land or livestock) to shoulder health expenses. The urgency of revising the health financing system has been recognized by the Cambodian government and relevant stakeholders. While the poor now have access to free health care, non-poor people who work in the informal sector - about 60% of the population - still need to pay for health care out of their pockets. The Cambodian government considers designing health insurance for them. Our experimental results suggest that people may be held accountable for not taking up insurance; potentially even if they lack the financial resources to pay for insurance premiums. These people are then worse off after the introduction of insurance because they neither have insurance nor enjoy the same level of informal support as before. One implication of these findings is that health insurance should be made mandatory (with progressive contributions).
Projektbezogene Publikationen (Auswahl)
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Insurance and Solidarity – Evidence from a Lab-in-the- Field Experiment in Cambodia. Discussion paper series / IZA Institute of Labor Economics ; no. 10986
Friederike Lenel & Susan Steiner
