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SEWA Wage Insurance Experiment
Last registered on July 02, 2019

Pre-Trial

Trial Information
General Information
Title
SEWA Wage Insurance Experiment
RCT ID
AEARCTR-0004240
Initial registration date
June 20, 2019
Last updated
July 02, 2019 1:43 PM EDT
Location(s)

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Primary Investigator
Affiliation
University of Chicago
Other Primary Investigator(s)
PI Affiliation
University of Chicago
PI Affiliation
University of Chicago
PI Affiliation
University of California-Berekeley
PI Affiliation
University of Chicago
PI Affiliation
Stanford University
Additional Trial Information
Status
In development
Start date
2019-06-26
End date
2021-03-31
Secondary IDs
Abstract
We present the motivation, design and analysis plan for the SEWA Wage Insurance Experiment (SWIE). The SWIE is a randomized controlled trial examining the impacts of providing so-called “hospi-cash" insurance that provides a per-diem indemnity payment while a beneficiary is hospitalized. We brand this a wage insurance product given SEWA' motivation for offering it, though it covers non-medical costs of hospitalization other than lost wages. The SWIE offers roughly 200 villages simultaneous access to two wage insurance plans, one with higher coverage and a higher price and one with lower coverage and lower price. The SWIE randomizes the prices to which villages are offered access to these two plans. The SWIE has two methodological innovations. First, it identifies bounds on demand using the approach in Tebaldi et al. (2018). Second, we develop an approach to choose prices so as to minimize the width of these bounds. The SWIE examines impacts on hospi-cash insurance uptake, health insurance uptake, hospi-cash insurance claims, and health care utilization. It also estimates adverse selection into and moral hazard from wage insurance.
External Link(s)
Registration Citation
Citation
Mahajan, Aprajit et al. 2019. "SEWA Wage Insurance Experiment." AEA RCT Registry. July 02. https://doi.org/10.1257/rct.4240-1.0.
Former Citation
Mahajan, Aprajit et al. 2019. "SEWA Wage Insurance Experiment." AEA RCT Registry. July 02. https://www.socialscienceregistry.org/trials/4240/history/49117.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
We offer households the ability to purchase two hospi-cash policies at certain prices (i.e., premiums). The two policies differ in their coverage.
Intervention Start Date
2019-09-11
Intervention End Date
2020-05-31
Primary Outcomes
Primary Outcomes (end points)
1. Uptake of each of the 2 selected hospi-cash products
2. Uptake of SEWA’s health insurance product and savings product
3. Days of hospitalization, by each member adult member and by any minor members of the household. In addition, the number of days reimbursed by health insurance.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
1. Number of days of work in last month and average daily wage on days worked
2. Asset index
3. Savings
4. Monthly consumption budget (net of medical expenses)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
This study will include two pilot surveys, a baseline survey, and an end line survey approximately one year after the end of the baseline. We will be running this experiment in 219 villages in Ahmedabad and Gandhinagar, two districts in the Indian state of Gujarat, which have 35,329 current and former SEWA members.

In both pilots, we conduct surveys in three representative villages in Ahmedabad and two representative villages in Gandhinagar. Within each village, we select 50 representative households, yielding a total of 250 households in the first pilot and 250 households in the second pilot. Villages selected for the pilots are excluded from the main study.

During the first pilot, we implement a willingness-to-pay exercise in five villages in Ahmedabad and Gandhinagar to determine which two products yield the most consumer surplus. We vary the products along two dimensions: indemnity rates (i.e., amount of money paid out when a claim is made) and coverage (i.e., number of people in a household covered). Within each village, we randomly assign 25 households to the insurance product that varies along the indemnity rate dimension, but is fixed along the coverage dimension, and 25 to the insurance product that varies along the coverage dimension, but is fixed along the indemnity rate dimension. We then choose the two products with the greatest consumer surplus.

Approximately two weeks after the first pilot ends, the second pilot will begin. During the second pilot, we conduct another willingness-to-pay exercise focused on the two products selected in the first pilot. This pilot is conducted on survey respondents in a different set of five villages in Ahmedabad and Gandhinagar to determine optimal prices for the two products we've selected after the first pilot.

After the pilots, we randomly assign the remaining 209 villages to one of the two possible prices for each of the two products offered. Again, within each village, we select 50 representative households, yielding a total of 10,450 households total. SEWA representatives will offer the two hospi-cash policies selected in pilot 1 to households in each village at the prices assigned to that village. SEWA will also continue to offer it's standard suite of non-hospi-cash policies to SEWA households. This hospi-cash marketing push will last 6 to 9 months.

At the beginning of the marketing push we will conduct a baseline survey of sample households. After the marketing push, we will gather data from SEWA on which households purchased a hospi-cash policy and which one they purchased. We will also obtain from SEWA claims data for one year for for all sample households that enroll in a hospi-cash plan . Approximately one year after the end of the baseline, we will conduct an end line.

We will estimate the causal impact of price on uptake of hospi-cash policies using an ITT design. We will back out bounds on the demand function using Tebaldi et al. (2018). We will examine the impact of enrollment in wage insurance on the uptake of SEWA's health insurance product, utilization of hospital care, employment, and household financial planning using randomized prices as an instrument in a TOT design. This design will also enable us to estimate adverse selection into and moral hazard from wage insurance.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
The unit of of randomization is a village. Each of the 209 villages are randomly assigned to a price 2-tuple for each of the 2 chosen products.
1. Villages are first sorted into 2-tuples based on the similarity of certain village-level features
2. In each 2-tuple, villages are randomly assigned (without replacement) to each of the 4 possible price combinations for the two wage insurance policies.
All 209 villages are offered SEWA’s standard health insurance product at the SEWA-set premium.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
209 villages
Sample size: planned number of observations
10,450 SEWA members
Sample size (or number of clusters) by treatment arms
5,225 households randomized into each product's treatment arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
University of Chicago Social and Behavioral Sciences IRB
IRB Approval Date
2019-06-18
IRB Approval Number
IRB19-0219
IRB Name
Institute for Financial Management and Research
IRB Approval Date
2019-06-11
IRB Approval Number
IRB00007107