Date
2011
Dewey
Economie sociale
Sujet
France; Subsidized Health insurance; low-income population; uninsured; randomized experiment
JEL code
I38; I18; D81; C93
Conference name
60e Congrès AFSE
Conference date
09-2011
Conference city
Paris (Nanterre)
Conference country
France
Author
Guthmuller, Sophie
Wittwer, Jérôme
Jusot, Florence
Type
Communication / Conférence
Abstract (EN)
In order to improve financial access to complementary health insurance (CHI) in France, a CHI voucher program,
called Aide Complémentaire Santé (ACS) was introduced in 2005. Four years later, the program covered only
18% of the eligible population. Two main hypotheses are put forward to account for this low take-up rate. The
first one is related to the lack of information on the program itself and on its application process. While the
second one considers that the amount of the financial support is too small to encourage people to purchase a
CHI plan. We conduct a controlled experiment with the National Health Insurance Fund in order to assess these
assumptions. A sample of eligible insurees living in an urban area in northern France were randomly split into
three groups: a control group who received the standard level of financial aid, a group benefiting from a 75%
voucher increase, and a third group benefiting from the same 75% voucher increase plus an invitation to an
information meeting on ACS.
After six months of follow-up, we observed how many application forms were sent back and how many of them
entitled to ACS. Five main conclusions can be drawn from that analysis. (1) The voucher increase has a slight but
statistically significant effect on ACS take-up. (2) It also allows better targeting of people actually eligible and
thus reduces the number of ACS refusals due to resources above the upper limit. (3) However the invitation to
the meeting seems unexpectedly to cancel the positive effect of the voucher increase when both treatments are
applied jointly. (4) On the contrary, after controlling for potential selection bias, we observed that attending the
briefing has a significant impact on ACS take-up. (5) This study confirms that ACS is complex and reaches poorly
its target population. Only 17% of the insurees applied for ACS and only 9% of insures who were invited to the
information briefing actually attended it. Moreover, previous CHI holders responded similarly to CHI non holders
to treatments, which suggests that the central issue of ACS low take-up rate is not the CHI cost itself but most
certainly the access to information, the burden and the complexity of the application process.