  We study long-run selection and treatment effects of a health insurance
subsidy in Ghana, where mandates are not enforceable. We randomly provide
different levels of subsidy (1/3, 2/3, and full), with follow-up surveys seven
months and three years after the initial intervention. We find that a one-time
subsidy promotes and sustains insurance enrollment for all treatment groups,
but long-run health care service utilization increases only for the partial
subsidy groups. We find evidence that selection explains this pattern: those
who were enrolled due to the subsidy, especially the partial subsidy, are more
ill and have greater health care utilization.
