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Understanding Consumer Preferences in the Context of Managed Competition: Evidence from a Field Experiment in Rural Colombia

Bogota, Colombia


Throughout the world, access to health services is a key determinant of improving health. In many countries, health insurance is the primary vehicle for accessing care. Initially, governments can increase funding for health insurance with dramatic effects. After a certain period, however, the return on this investment falls and governments struggle to achieve universal coverage. Evidence suggests that complex individual behavior may play a role. Colombia is one such example. The uninsured rate dropped over 40% after Colombia’s 1993 reforms, but roughly 2.5 million people are still without coverage. Using a field experiment, we will explore how rural Colombians value health insurance, and whether their values differ from their urban peers. Taking this behavioral approach, we hope to shed light on why persistent gaps in rural insurance coverage remain, despite Colombia’s fiscal efforts to establish a low-cost plan. We recently completed a field experiment for urban Colombians. By expanding this work, we will explore whether insurance preferences vary between rural and urban individuals with similar demographic and income characteristics. Most previous preference work assumes that values do not vary widely across a population, as small sample sizes have been used in relatively homogenous countries. Our study will be one of the first to take a consumer-driven approach to compare insurance preferences in rural and urban areas. This research will help Colombia’s insurers and policy makers design more effective policies to achieve universal coverage. The results will enhance the understanding of insurance choices in other countries facing similar challenges.


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