Formal Insurance and productive effects study (FIdES)

The purpose of this project is to analyse the direct effects as well as the indirect effects of community based health insurance (CBHI) in Burkina Faso. The direct effects relate to health care utilization and health. The indirect effects relate to investment in education and productive farm and non-farm capital.

Households in Burkina Faso are frequently exposed to shocks including health shocks and formal risk management devices such as formal insurance, or credit and savings accounts are largely absent. To identify causal effects, the roll-out of CBHI is accompanied by a randomized encouragement design introducing randomness in the insurance uptake.

Thus far, the potential indirect effects of health insurance on investment are poorly understood and have not yet been studied in depths empirically. Moreover, there is still little evidence on how formal insurance mechanisms interact with traditional informal insurance arrangements and sharing norms. To our knowledge, the results from the project will constitute the first causal evidence on the relationship between insurance of household-related risks and productive investment. If these effects are shown to be economically significant, health insurance and alike would generate benefits that clearly go beyond the direct health and income effects.

Precisely the project aims to address the following four research questions:

¬ What determines uptake of CBHI and how can uptake sustainably be enhanced?

¬ What are the impacts of CBHI on health care utilization and health?

¬ What are the effects of CBHI on investment in productive farm and non-farm capital as well as human capital?

¬ How does access to health insurance affect informal sharing networks and sharing norms?

Burkina Faso is currently promoting the creation and expansion of CBHI as basis for a national scheme to evolve. The project will thus also provide further and complementary evidence on the potential impact of such an intervention.

The project and debate was also featured in an ARTE-documentary:

Der Glanz der Schattenwirtschaft

Der Glanz der Schattenwirtschaft

Project website and further material