Nudging households to take up health insurance : evidence from a randomized experiment in Burkina Faso

In this paper we analyze the impact of a randomized information package on the understanding and uptake of community based health insurance. The information package consists of a detailed brochure which is distributed to households through home visits, a video also presented in people's homes and a personalized phone reminder. Overall, we find significant treatment effects on insurance uptake at the margin, although insurance uptake is low in general. We also find evidence for a better understanding of insurance principles among treated households, in particular in poorer households and in households with literate household heads. Finally, we see that treated households share the information they received with their neighbors and this also has positive effects on their understanding of insurance principles. We find further suggestive evidence that information sharing remains locally concentrated and does not surpass a radius of 1 km. Our findings contribute to the understanding how knowledge about the functioning of insurance can be enhanced in a context where the concept of insurance is largely unknown and where strong cultural beliefs prevail, and eventually, how insurance uptake can be increased, although the latter may take more time.