Does religiosity substitute for formal insurance and formal health care? – Experimental evidence from Côte d’Ivoire

Given that poor households in developing countries have very limited access to formal insurance, we hypothesize that religious engagement—such as praying or donating to the church—serves as an informal coping mechanism against adverse shocks. We further examine whether poor individuals rely on religious practices as a substitute for formal health care when ill. Using randomized health insurance offers and high-frequency measures of religious activities as outcomes, we test whether households reduce their religious engagement once formal insurance becomes available. Consistent with our hypothesis, we find that insurance enrollment reduces households’ engagement in religious vows. Our results further suggest that spiritual health care tends to complement, rather than replace, formal health care.