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Title: Health Insurance for Seasonal Savings: Evidence from Rural C么te d'Ivoire

Authors: G眉nther Fink, B. Kelsey Jack, Renate Strobl, Dao Daouda

Abstract: Households in low-income agricultural economies face large seasonal fluctuations in income and limited access to financial tools for smoothing consumption. In such settings, health insurance can serve not only as risk protection, but also as a state-contingent savings technology, transferring resources from high-income harvest periods to low-income lean periods. We study the rollout of C么te d'Ivoire's national health insurance scheme in a context with high morbidity, substantial out-of-pocket expenditures, and pronounced income seasonality---conditions under which the potential welfare gains from insurance are particularly large. Using a randomized subsidy design among 2,468 cocoa-farming households, we show that insurance demand is highly responsive to both price and cash-on-hand liquidity. Despite strong demand and actuarially favorable pricing, we find limited effects on health spending or consumption. We show that this disconnect arises from frictions in accessing benefits, including weak verification and reimbursement environments that limit providers' willingness to honor coverage without immediate proof. Our results highlight the importance of implementation, trust, and contract enforceability in determining the welfare impacts of social insurance.