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Citizen Information and Hospitals' Compliance with Health Insurance Scheme
Last registered on May 21, 2018

Pre-Trial

Trial Information
General Information
Title
Citizen Information and Hospitals' Compliance with Health Insurance Scheme
RCT ID
AEARCTR-0002997
Initial registration date
May 20, 2018
Last updated
May 21, 2018 3:29 PM EDT
Location(s)
Region
Primary Investigator
Affiliation
Stanford University
Other Primary Investigator(s)
PI Affiliation
Harvard School of Public Health
Additional Trial Information
Status
On going
Start date
2018-03-29
End date
2019-06-30
Secondary IDs
Abstract
This study aims to test the extent to which a low-cost information campaign among eligible beneficiaries increases hospital compliance with a public health insurance program in a large Indian state. Specifically, the study will use survey and administrative data, combined with a randomized phone-based information intervention, to quantitatively assess 1) the prevalence and magnitude of out-of-pocket payments by patients in principle covered free of charge, and 2) whether provision of information to beneficiaries about their entitlements and participating hospitals under the insurance program can enable them to hold hospitals accountable, negotiate better, and find the hospital that best meets their needs.
External Link(s)
Registration Citation
Citation
Dupas, Pascaline and Radhika Jain. 2018. "Citizen Information and Hospitals' Compliance with Health Insurance Scheme." AEA RCT Registry. May 21. https://doi.org/10.1257/rct.2997-1.0.
Former Citation
Dupas, Pascaline, Pascaline Dupas and Radhika Jain. 2018. "Citizen Information and Hospitals' Compliance with Health Insurance Scheme." AEA RCT Registry. May 21. http://www.socialscienceregistry.org/trials/2997/history/29809.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
We are conducting a phone-based experiment to test whether information about the health insurance scheme can help patients hold hospitals accountable and reduce cash outlays. If effective, this will confirm that hospitals are exploiting patient lack of information, provide insights into the role information plays in these markets, and demonstrate that information can empower patients to hold hospitals accountable.

The exact information provided is as follows:
Verbal at end of phone survey:
"I would like to give you information about the Government of XXX [SCHEME NAME]. The program covers the full costs of dialysis, including hospital care, tests, and medicines. You and your household are eligible. You just need to show your XX card number. All public hospitals and many private hospitals are included in the program. [ClaimHosp], where you have gone for dialysis before, is included. The hospital receives between 1500 and 2000 rupees from the [SCHEME NAME] for each of your dialysis visits. These are the names of other hospitals that are within 10 kilometers of that hospital, and that are also included in the SCHEME: NbrHosp1, NbrHosp2, NbrHosp3. Dialysis and related tests and medicines should be free under [SCHEME NAME] at all these places.”

By SMS following the survey:
"Under [SCHEME NAME] your dialysis, tests, and medicines should be free. The hospital receives between 1500 and 2000 rupees from the Yojana for each of your dialysis visits. These hospitals close to you do dialysis and are included in the SCHEME: ClaimHosp, NbrHosp1, NbrHosp2, NbrHosp3”
Intervention Start Date
2018-03-29
Intervention End Date
2018-05-31
Primary Outcomes
Primary Outcomes (end points)
From survey data: Knowledge of the scheme's benefits, negotiating with the hospital, switching to other hospitals, cash paid
From administrative data: hospital switching
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Quality of care received
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The experiment focuses on dialysis patients because they visit a facility repeatedly (so information may affect subsequent visits) and because dialysis is a relatively standardized service. Dialysis patients identified as having received dialysis care in a participating hospital in the recent past as per the administrative claims data were stratified by hospital and randomly assigned to three groups.

T1 Group: Patients receive detailed information about the program, their benefits, and names of participating hospitals, at the end of a baseline survey. Information is first provided verbally at the end of the phone survey, and is also sent to the respondent as an SMS. This group will be surveyed again for a midline 4 weeks later. At that time the information will be repeated to them. They will be surveyed again for an endline 8 weeks later.

T2 Group: These patients will be surveyed twice, at midline and endline. They will receive the detailed BSBY information at the end of the midline survey. They will receive the information only once.

Control group: only surveyed at endline.

The T1 group baseline, T2 group middline and Control endline surveys are the same and will allow us to check that the randomization successfully ensured that time invariant characteristics between the groups are similar on average. The T1 and T2 Group endline survey is almost the same but simply excludes questions about time-invariant characteristics that were already asked at baseline/midline; we will compare the endline survey data and the administrative data across the three groups to assess any difference in outcomes between patients that received the information treatment once or twice or not at all. We will compare the midline outcomes between T1 and T2, as well as the endline outcomes between Control and T2, to estimate the impact of receiving the information once.
We will look at heterogeneity by the density of hospitals in the area, since the ability to bargain with a hospital is likely a function of outside options available.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Individual
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
1185
Sample size: planned number of observations
1185
Sample size (or number of clusters) by treatment arms
T1: 449
T2: 434
Control: 302
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Harvard T.H. Chan School of Public Health
IRB Approval Date
2018-05-01
IRB Approval Number
IRB18-0131
IRB Name
Stanford University
IRB Approval Date
2018-03-23
IRB Approval Number
#41683
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS