Séminaire d’économie de Bordeaux

Laurène Petitfour

(IRD)

Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso

Delphine Boutin, Laurène Petifour, Yvonne Allard, Souleymane Kontoubré, Valéry Ridde

Offering health coverage to informal workers and their families remains a significant challenge in most Sub-Saharan countries. As linking insurance to employment contracts is not possible and demand for insurance is too low to sustain voluntary schemes, alternative approaches are required. One such approach is bundling health insurance with microcredit, which we evaluate in this study. We conducted a cluster randomized controlled trial to assess the impact of a compulsory micro-health insurance scheme bundled with microcredit in Ouagadougou, Burkina Faso. Among the 88 active microcredit groups (44 treated, 44 control), we analyzed outcomes for 1,095 individuals who reported illness episodes in the six months preceding the endline survey. We evaluated the effects of health insurance subscription on financial protection, healthcare utilization, and health outcomes, estimating both the intention-to-treat effect (ITT) and the local average treatment effect (LATE). Our findings indicate no evidence of selective attrition or members opting out of the Microfinance Institution (MFI) due to the health insurance requirement; loan renewal rates remained consistent across treatment groups. Health insurance substantially and positively impacted financial protection: out-of-pocket expenditures decreased by over 50%, and payment difficulties dropped by approximately 36%. The insurance also influenced healthcare-seeking behaviors, with a marginally significant increase in modern healthcare facility use (+5%), a significant reduction in traditional medicine use (-61%), and improved timely care-seeking, as more individuals sought care on the same day symptoms appeared (+23%). However, no significant impact on physical or psychological health outcomes was observed. These results suggest that compulsory health insurance can provide meaningful financial protection against health risks for MFI members who lack social protection, without compromising the MFI’s retention rate. While it encourages appropriate and timely healthcare use, direct health impacts may require indirect and long-term mechanisms to emerge, making them more challenging to detect.

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