Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam

Subsidized voluntary enrollment in government‐run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. We report the results of a cluster randomized experiment, in which 3000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government‐run scheme and the benefits of health insurance, a voucher entitling eligible household members to 25% off their annual premium, and both. At baseline, the four groups had similar enrollment rates (4%) and were balanced on plausible enrollment determinants. The interventions all had small and insignificant effects (around 1 percentage point or ppt). Among those reporting sickness in the 12 months prior to the baseline survey the subsidy‐only intervention raised enrollment by 3.5 ppts (p = 0.08) while the combined intervention raised enrollment by 4.5 ppts (p = 0.02); however, the differences in the effect sizes between the sick and non‐sick were just shy of being significant. Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.     

Language Proficiency and the Enrollment of Medicaid-Eligible Children in Publicly Funded Health Insurance Programs

Objectives: The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program. Methods: 1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted ² tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics. Results: Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to know-how—that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes. Conclusions: This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency.     

The Effect of Parental Immigration Authorization on Health Insurance Coverage for Migrant Latino Children

Objective: To examine if immigration authorization among parents is associated with health insurance coverage for migrant Latino children. Data Source: A cross-sectional household survey of 300 migrant families for which one child, aged <13 years, was randomly selected. Results: Most children lacked insurance (73%) and had unauthorized parents (77%). Having an authorized parent or parental stay of more than 5 years in the US were each positively associated with children’s health insurance coverage [OR: 4.9; 95% CI: (2.7–8.7) and [OR = 6.7; 95% CI: (3.8–12.0), respectively]. The effect of parental authorization did not persist in multivariable logistic regression analysis; however, more than 5 years of parental stay in the US remained associated with children’s insurance coverage [OR = 4.8; 95% CI (1.8–12.2)], regardless of parental authorization. Conclusion: Increased parental familiarity with US health and/or social services agencies, rather than parental authorization status, is important to obtaining health insurance for migrant children. Efforts to insure eligible migrant children should focus on recently arrived families.     

Understanding factors influencing home delivery in the context of user‐fee abolition in Northern Ghana: Evidence from 2014 DHS

User‐fee exemption for skilled delivery services has been implemented in Ghana since 2003 as a way to address financial barriers to access. However, many women still deliver at home. Based on data from the 2014 Ghana Demographic and Health Survey, we estimated the prevalence of home delivery and determined the factors contributing to homebirths among a total of 622 women in the Northern region in the context of the user‐fee exemption policy in Ghana. Binary and multivariate logistic regression analyses were employed. Results suggest home delivery prevalence of 59% (365/622). Traditional birth attendants attended majority of home deliveries (93.4%). After adjusting for potential confounders, making less than four antenatal care visits (aOR = 2.42; CI = 1.91‐6.45; p = 0.001), being a practitioner of traditional African religion (aOR = 16.40; CI = 3.10‐25.40; p = 0.000), being a Muslim (aOR 2.10; CI = 1.46‐5.30; p = 0.042), not having a health insurance (aOR = 1.85; CI = 1.773‐4.72; p = 0.016), living in a male‐headed household (aOR = 2.07; CI = 1.02‐4.53; p < 0.01), and being unexposed to media (aOR = 3.10; CI = 1.12‐5.38; p = 0.021) significantly predicted home delivery. Our results suggest that unless interventions are implemented to address other health system factors like insurance coverage, and socio‐cultural and religious beliefs that hinder uptake of skilled care, the full benefits of user‐fee exemption may not be realized in Ghana.     

Weight Loss Favorably Modifies Anthropometrics and Reverses the Metabolic Syndrome in Premenopausal Women

Objective: To determine the effects of a weight loss program, including dietary modifications, increased physical activity and dietary supplement (L-carnitine or placebo) on anthropometrics, leptin, insulin, the metabolic syndrome (MS) and insulin resistance in overweight /obese premenopausal women.

Methods: Participants consumed a hypocaloric diet; 30% protein, 30% fat and 40% carbohydrate in addition to increasing number of steps/day. Carnitine supplementation followed a randomized double blind protocol. Protocol lasted for 10 weeks. Seventy subjects (35 in the control and 35 in the carnitine group) completed the intervention. Anthropometrics, plasma insulin and leptin concentrations and body composition were measured. The number of subjects with the MetSyn and insulin resistance, were assessed at baseline and post-intervention.

Results: Because there were no significant differences between the carnitine and the placebo groups for all measured parameters, participants were grouped together for all analysis. Subjects decreased total energy (?26.6%, p < 0.01) and energy from carbohydrate (?17.3%, p < 0.01) and increased energy from protein by 67% (p < 0.01) and number of steps/day (42.6%, p < 0.01). Body weight (?4.6%, p < 0.001), body mass index (?4.5%, p < 0.01), waist circumference (?6.5%, p < 0.01), total fat mass (?1.7%, p < 0.01), trunk fat mass (?2.0%, p < 0.01), insulin (? 17.9%, p < 0.01) and leptin (?5.9%, p < 0.05) decreased after the intervention. Ten of 19 participants with insulin resistance became insulin sensitive and 7 of 8 participants with the MetSyn no longer had the syndrome after the intervention.

Conclusion: Moderate increases in physical activity and a hypocaloric/high protein diet resulted in multiple beneficial effects on body anthropometrics and insulin sensitivity. Realistic dietary and physical activity goals must be the focus of intervention strategies for overweight and obese individuals.     

Healthy and Ready to Learn: Effects of a School‐Based Public Health Insurance Outreach Program for Kindergarten‐Aged Children

BACKGROUND

Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school‐based health insurance outreach initiative, “Healthy and Ready to Learn,” aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina.

METHODS

Regression discontinuity design and difference‐in‐differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well‐child visits; secondary outcome). Focus groups and key‐informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment.

RESULTS

The initiative increased enrollment rates by 12.2% points and increased well‐child exam rates by 8.6% points in the RD models, but not differences‐in‐differences, and did not significantly increase well‐child visits.

CONCLUSIONS

Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low‐income parents.     

Predictors of choice of public and private maternity care among nulliparous women in Ireland,and implications for maternity care and birth experience

Maternity care in Ireland is provided through a mixture of free public and fee-based private or semi-private services. We examined factors associated with choice of care pathway among nulliparous women and how this influences the care they receive and their experience of childbirth using data from a prospective cohort study. Complete data were available for 1,789 women on choice of care pathway and birth outcomes, and for 1,336 women on birth experience. Maternal age (marginal effect [ME] 1.6 percentage points [ppts], p < 0.01), socioeconomic status (ME 0.5ppts, p < 0.01) and being born in Ireland (ME 10.3ppts, p < 0.01) were all positively associated with choosing private care, but level of risk in early pregnancy did not influence this decision. Intervention rates in public and semi-private care were comparable, but women in private care were more likely to receive epidural anaesthesia (odds ratio [OR] 1.65, p < 0.01) and give birth by caesarean section (ratio of relative risks [RRR] 1.98, p < 0.01). Private care was also associated with longer hospital stays (28 % longer, p < 0.01). Increased risk was negatively correlated with birth experience in public and semi-private care, but not in private care. Policies promoting the allocation of maternity care resources by level of risk, along with the standardisation of clinical practice across care pathways, could reduce rates of obstetric intervention and address risk-based disparities in birth experience outcomes.     

An Urban School Based Comparative Study of Experiences and Perceptions Differentiating Public Health Insurance Eligible Immigrant Families with and without Coverage for their Children

Introduction We explore why some low income immigrant families enroll in government financed health insurance plans for their children, while others also eligible do not enroll. Methods Our team conducted and analyzed audiotaped semi-structured interviews with families of 8 insured and 10 uninsured children focused on knowledge of and experience with seeking health insurance coverage. Results Common among families not enrolled in government sponsored plans were misperceptions about the insurance system, including a suspicion of the government monitoring them and/or lack of familiarity with the concept of insurance itself. Among families that did enroll, the predominant theme was the essential role of their sponsor, other kin or community in educating and assisting them with the application process. Conclusions Prior research has identified external obstacles to enrollment. Our findings indicate the additional importance of facilitating social support, particularly from sponsors in mentoring new arrivals through the process of seeking insurance coverage.     

Activities with Higher Influence on Quality of Life in Older Adults in Japan

The present study aimed to investigate the influence of 10 activities on quality of life (QOL) in Japanese older adults and to verify which activities had higher influence on QOL level. The subjects were 465 Japanese community‐dwelling older adults. QOL was assessed by the brief version of the World Health Organization Quality of Life (WHOQOL‐BREF) and the complementary assessment to measure the QOL of older adults (WHOQOL‐OLD) module. Activity and participation were measured through a questionnaire concerning frequency of engagement in several activities. The activity with the highest influence on WHOQOL‐BREF was physical activity (β = 0.209, p < 0.01), followed by art activity (β = 0.169, p < 0.01) and reading and writing (β = 0.141, p < 0.01). The activity with the highest influence on WHOQOL‐OLD was social activity (β = 0.222, p < 0.01), followed by reading and writing activity (β = 0.118, p < 0.05). The limitations of this study were the proportion of subjects and the place of recruitment. Further studies investigating in deep the relation between QOL and activity and participation, and other subjective and environmental factors that may influence the QOL are still needed among a higher and homogeneous subjects sample. Copyright © 2012 John Wiley & Sons, Ltd.     

Workplace building design and office‐based workers' activity: a study of a natural experiment

Objective : This opportunistic natural study investigated the effects of relocation of office workers from a 30‐year‐old building to a new purpose‐built building. The new building included an attractive central staircase that was easily accessed and negotiated, as well as breakout spaces and a centralised facilities area. The researchers aimed to determine the impact of the purpose‐built office building on the office workers' sedentariness and level of physical activity. Method : In 2013, a natural pre‐post study was undertaken with office‐based workers in their old conventional 1970s building and on relocating to a new purpose‐built ‘activity permissive’ building. Objective movement data was measured using accelerometers. Anthropometric and demographic data was also collected. Results : Forty‐two office‐based workers significantly decreased their percentage of daily sitting time (T1 = 84.9% to T2=79.7%; p<0.001) and increased their percentage of daily standing time (T1=11.2% to T2 17.0%; p<0.001) in the new building. Moderate activity significantly declined (T1=3.9% to 3.2%=T2; p=0.038). There was a significant decrease in mean minutes of sitting time (19.62 minutes; p<0.001) and increase in standing time (22.03 minutes; p<0.001). Conclusions : The design of a building can influence activity. This opportunistic study on the impact of workplace relocation on office‐based workers' activity showed modest positive outcomes in sitting and standing. Evidence is required to inform building design policy and practice that supports physical activity and reduces levels of sedentariness in the workplace.     

Differences in cardiometabolic risk markers among ethnic groups in Queensland,Australia

Very little is known about the cardiometabolic risk of migrants who settle in Australia. This study investigated differences in cardiometabolic risk markers among ethnic groups attending a tailored healthy lifestyle program in Queensland, Australia; and differences in these markers between those living in Australia for shorter versus longer periods of time. Baseline data collected between October 2014 and June 2017 from the Living Well Multicultural—Lifestyle Modification Program were used. People living in ethnic communities in Queensland who were ≥18 years old, and not underweight were eligible to participate. Independent variables were ethnicity and length of time in Australia. Outcomes were cardiometabolic risk markers including BMI, waist circumference, weight‐to‐height ratio (WHtR) and hypertension. Analyses were done separately for each independent variable. Linear and logistic regressions were run for continuous and binary outcomes with differences/Odds ratios reported respectively. Multivariable analyses showed that Burmese/Vietnamese had an average BMI lower than Afghani/Arabic (3.7 points), Somalian/Sudanese (4.7 points) and Pacific Islander (11.6 points) (p < 0.001) respectively. Differences in waist circumference between Burmese/Vietnamese with Sri Lankan/Bhutanese, Afghani/Arabic, Somalian/Sudanese and Pacific Islander were 6.3, 8.4, 9.1 and 24.0 cm (p < 0.01) respectively. Although Burmese/Vietnamese also had lower average WHtR compared to the others, the differences were not significant for Somalian/Sudanese. Moreover, Sri Lankan/Bhutanese and Pacific Islander were more likely to be hypertensive compared to Burmese/Vietnamese (p < 0.05). Immigrants living in Australia >5years had on average 1.2 points higher BMI, 2.4cm larger waist circumference, and 0.02 points higher WHtR (p < 0.05) compared to those living for ≤5 years. Long‐stay immigrants were also more likely to be hypertensive than short‐stay immigrants (p < 0.01). In conclusion, cardiometabolic risk is significantly different among ethnic groups in Queensland with Pacific Islanders having the highest risk. Immigrants living in Australia >5 years had higher risks compared to those living in Australia for shorter periods of time.     

Cost–benefit analysis of the CoCare intervention to improve medical care in long-term care nursing homes: an analysis based on claims data

Background

Providing adequate medical care to nursing home residents is challenging. Transfers to emergency departments are frequent, although often avoidable. We conducted the complex CoCare intervention with the aim to optimize nursing staff–physician collaboration to reduce avoidable hospital admissions and ambulance transportations, thereby reducing costs.

Methods

This prospective, non-randomized study, based on German insurance data, includes residents in nursing homes. Health care cost from a payer perspective and cost–savings of such a complex intervention were investigated. The utilisation of services after implementation of the intervention was compared with services in previous quarters as well as services in the control group. To compensate for remaining differences in resident characteristics between intervention and control group, a propensity score was determined and adjusted for in the regression analyses.

Results

The study population included 1240 residents in the intervention and 7552 in the control group. Total costs of medical services utilisation were reduced by €468.56 (p < 0.001) per resident and quarter in the intervention group. Hospital stays were reduced by 0.08 (p = 0.001) and patient transports by 0.19 (p = 0.049). This led to 1.66 (p < 0.001) avoided hospital days or €621.37 (p < 0.001) in costs–savings of inpatient services. More services were billed by general practitioners in the intervention group, which led to additional costs of €97.89 (p < 0.001).

Conclusion

The benefits of our intervention clearly exceed its costs. In the intervention group, avoided hospital admissions led to additional outpatient billing. This indicates that such a multifactorial intervention program can be cost-saving and improve medical care in long-term care homes.

     

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p < 0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p < 0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p < 0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p < 0.01) less likely to have a functional limitation due to vision.     

Household Size and the Decision to Purchase Health Insurance in Cambodia: Results of a Discrete-Choice Experiment with Scale Adjustment

Background

Community-based health insurance (CBHI) schemes have been introduced in low- and middle-income countries to increase health service utilization and provide financial protection from high healthcare expenditures.

Objective

We assess the impact of household size on decisions to enroll in CBHI and demonstrate how to correct for group disparity in scale (i.e. variance differences).

Methods

A discrete choice experiment was conducted across five CBHI attributes. Preferences were elicited through forced-choice paired comparison choice tasks designed based on D-efficiency. Differences in preferences were examined between small (1–4 family members) and large (5–12 members) households using conditional logistic regression. Swait and Louviere test was used to identify and correct for differences in scale.

Results

One-hundred and sixty households were surveyed in Northwest Cambodia. Increased insurance premium was associated with disutility [odds ratio (OR) 0.61, p < 0.01], while significant increase in utility was noted for higher hospital fee coverage (OR 10.58, p < 0.01), greater coverage of travel and meal costs (OR 4.08, p < 0.01), and more frequent communication with the insurer (OR 1.33, p < 0.01). While the magnitude of preference for hospital fee coverage appeared larger for the large household group (OR 14.15) compared to the small household group (OR 8.58), differences in scale were observed (p < 0.05). After adjusting for scale (k, ratio of scale between large to small household groups = 1.227, 95 % confidence interval 1.002–1.515), preference differences by household size became negligible.

Conclusion

Differences in stated preferences may be due to scale, or variance differences between groups, rather than true variations in preference. Coverage of hospital fees, travel and meal costs are given significant weight in CBHI enrollment decisions regardless of household size. Understanding how community members make decisions about health insurance can inform low- and middle-income countries’ paths towards universal health coverage.

     

Reforming foodservice in elderly care: National actions and local outcomes

Aim

The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions.

Methods

A survey using a web‐based questionnaire about elderly care foodservice targeting all Swedish municipalities (n = 290) was conducted in 2006 and 2013/2014. The questionnaire included the topics: organisation of foodservice, its practice in elderly care and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%).

Results

The response rate from municipalities was 80% in 2006 and 56% in 2013/2014; 45% participated in both surveys. The results showed increased use of local food policies (P = 0.03) and meal choice (P < 0.001), while access to clinical/community dietitians declined (P = 0.01) between the surveys. In home‐help services, daily delivered cook‐serve meals declined (P < 0.001) and chilled meals delivered three times a week increased (P = 0.002) between the surveys. City municipalities used private foodservice organisations the most (P < 0.001), and reported reduced use of cook‐serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook‐serve system (94%) were firmly established. Urban municipalities were placed between the other groups.

Conclusions

National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences.     

Take-Up of Public Insurance and Crowd-Out of Private Insurance under Recent CHIP Expansions to Higher Income Children

Objective

To analyze the effects of states'' expansions of Children''s Health Insurance Program (CHIP) eligibility to children in higher income families on health insurance coverage outcomes.

Data Sources

2002–2009 Current Population Survey linked to multiple secondary data sources.

Study Design

Instrumental variables estimation of linear probability models. Outcomes are whether the child had any public insurance, any private insurance, or no insurance coverage during the year.

Principal Findings

Among children in families with incomes between two and four times the federal poverty line (FPL), four enrolled in CHIP for every 100 who became eligible. Roughly half of the newly eligible children who took up public insurance were previously uninsured. The upper bound “crowd-out” rate was estimated to be 46 percent.

Conclusions

The CHIP expansions to children in higher income families were associated with limited uptake of public coverage. Our results additionally suggest that there was crowd-out of private insurance coverage.     

Upper-extremity Musculoskeletal Disorders in Keyboard Operators in Brazil: A Cross sectional Study

Abstract

This study sought to determine the prevalenee of upper extremity musculoskeletal disorders (UEMSDs) among keyboard operators in Sao Paulo, Brazil, and to compare this prevalence with that among other office workers. One hundred and thirty keyboard operators (mean age 33 years, 60 male/70 female) and 138 office workers (mean age 35 years, 82 male/66 female) from two computing centers were interviewed by a research assistant using a standardized questionnaire. Symptomatic subjects, defined as those who reported upper extremity pain or lost work time due to pain in the preceding 12 month, were examined by a rheum-tologist. Mean (SD) lengths of employment were 9 (6) years for keyboard operators and 8 (6) years for office workers. Upper-extremity pain during the preceding seven days was reported by 66 keyboard operators (51%) and by 18 office workers (13%) (p < 0.0001); during the preceding 12 months, by 90 keyboard operators (69%) and by 26 office workers (19%) (p < 0.0001). UEMSDs were diagnosed following physical examination in 50 keyboard operators and in 12 office workers (9%) (p < 0.0001). Tenosynovit is was the most common disorder diagnosed among the keyboard operators (n = 23). Among the keyboard operators the prevalence of UEMSDs was significanlly lower for males (p = 0.017, OR = 0.38, 95% CI = 0.17–0.86. The presence of a diagnosed UEMSD was significantly associated with duration of employment (p = 0.005) and lack of or insufficient rest breaks (p = 0.012). Keyboard operators had significantly more UEMSDs than did office workers. Strategies aimed at the reduction of repetitive strain injuries among keyboard operators, such as the provision of adequate work breaks, should be evaluated.     

An examination of enrollment of children in public health insurance in New York City through facilitated enrollment

A cohort of families was followed through the enrollment process for Medicaid and Child Health Plus in New York City to determine success in enrollment and the time it takes to enroll. Families were recruited into the study by enrollers in community-based organizations and managed-care organizations. In our sample, three of four families were successful in enrolling. On average, it took 60 days to attain insurance. Most applicants (76%) received some sort of assistance from enrollers, most frequently in determining which documents were needed (74%). In a multivariable analysis, some of the factors associated with success in enrollment included being assisted by a community-based facilitated enroller, knowledge of required documents, and baving lost a child’s other bealth insurance.     

Density,distribution and periodicity of extra‐aquatic fungi and their correlation with physico‐chemical factors of different potable waters

Total fungal density (TFD), species composition, and distributional pattern of various species of extra‐aquatic fungi in different potable water sources at Bhagalpur has been determined. Analysis of physico‐chemical properties of water revealed significant positive correlations with TFD at p < 0.05 and p < 0.01 for river, municipal, handpump and boring water while an inverse relationship was obtained at p < 0.1 for well water. Maximum fungal density was observed in river water and minimum in handpump water. A total of 61 fungal species (Hyphomycetes, Zygomycetes and Pyrenomycetes) were identified. Periodicity was dependent upon different environmental factors. Recorded forms and the occurrence of extra‐aquatic fungi in different potable waters during most of the year may be considered as indicators of polluted waters. Many of them (Hyphomycetous members) are the representative of medical fungi which may cause different mycoses in human beings if such water is used for bathing and domestic purposes.     

The Impact of the Eligibility Threshold of a French Means‐Tested Health Insurance Programme on Doctor Visits: A Regression Discontinuity Analysis

This paper assesses the impact of eligibility for a free means‐tested complementary health insurance plan, called Couverture Maladie Universelle Complémentaire (CMUC), on doctor visits. We use information on the selection rule to qualify for the plan to identify the effect of eligibility and adopt a regression discontinuity approach. Our sample consists of low‐income individuals enrolled in the Health Insurance Fund and recipients of social benefits from the Family Allowance Fund of an urban area in Northern France. Our findings do not show significant impacts of the CMUC threshold on the number of doctor visits within the full sample. Among the subsample of adults under 30 years old, however, eligible individuals are more likely to see a specialist and have, on average, significantly more specialist visits than non‐eligible individuals. This specific impact of the CMUC cut‐off point among young adults may be explained by the fact that young adults are less likely to be covered by a complementary health insurance plan when they are not recipients of the CMUC plan. © 2017 The Authors. Health Economics Published by John Wiley & Sons, Ltd.