Microinsurance Utilization in Nicaragua: A Report on Effects on Children, Retention, and Health Claims

This report extends analysis on a randomized evaluation of voluntary health insurance in Managua, Nicaragua. The insurance coverage was offered by Nicaraguan Social Security Institute (INSS) to workers from informal sector. The coverage allowed patients to choose from a network of private and public providers. Its benefits included greater availability of free prescribed medications and shorter wait times. Researchers documenting the effects of recent expansions of formal health insurance systems have found conflicting results on the effects of insurance on health outcomes. The study discusses effects of health insurance on the children of those who were insured. It examines determinants of retention among the proportion of those who continued their coverage. It also presents descriptive statistics of the types of claims made at the covered health centers and costs. Findings include:

• There were large effects on visits to covered health providers, specifically on toddlers;
• Insurance product did not increase wasteful medical consumption;
• Insurance product resulted in some targeting towards less healthy children, as those who were sick at baseline reported significantly more visits to all providers;
• Only 6% of those insured were retained 18 months after subsidies were no longer available.