Jérôme Wittwer

Improving Takeup of Health Insurance Program: A Social Experiment in France

This paper is based on a randomized experiment conducted in order to understand the low takeup rate of a complementary health-insurance voucher program for the poorest in France. We explore two of the main hypotheses put forward to explain low enrollment: difficulties in accessing information about the program and a voucher amount considered to be too low. Results show that a voucher increase has a small but significant effect on takeup and the invitation to an information meeting discourages it. This study confirms the difficulties that are faced in increasing the healthinsurance coverage of poor populations via subsidy programs.

Responsibility-sensitive fairness in health financing: judgments in four European countries.

Risky health behaviours substantially increase medical and social costs. We document the extent to which a sample of European students (from Denmark, France, Italy and Sweden) consider that individuals should assume the financial burden of paying the costs of risky behaviour. We test the acceptability of different ways of financing costs because of ill health that is more or less associated with risky behaviour in accordance with a normative framework relating to responsibility-sensitive fairness. We find that the majority of students agree with assuming financial responsibility for risky behaviours and that there should be compensation for unfavourable circumstances. Students agree that two individuals with the same responsibility variables should make an equal financial contribution and that more effort in maintaining health for given circumstances should be rewarded with a lower financial contribution. The specific health context and the type of risky behaviours involved matter in determining perceptions of justice in health financing.