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- Convenors:
-
Jacinta Victoria S Muinde
(University of Oslo)
Ruth Prince (University of Oslo)
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- Stream:
- Health, Disease and Wellbeing
- Sessions:
- Thursday 1 April, -
Time zone: Europe/London
Short Abstract:
This panel seeks to explore, ethnographically, tensions and friction concerning solidarity, responsibility and care which surround recent experiments with and expansion of health insurance in many countries across the world.
Long Abstract:
The "Universal Health Coverage" agenda is redefining global health, as it foregrounds a language of universality, the right to health care and demands for equity, solidarity, and social justice. Under the umbrella of financial protection and increasing access to quality health care, attempts to expand health insurance have become a cornerstone of UHC policies. In much of the Global South, existing national health insurance schemes are parastatal and have historically been limited to people in formal employment. Attempts to extend insurance coverage means including people in the informal economy whose incomes are precarious. As digital, mobile and financial technologies crowd into this field, insurance is emerging as a field of experimentation, often combining a language of solidarity and a language of market innovation. This panel seeks to explore, ethnographically, these experiments with forms of solidarity: How are they positioned between the state and the market? How do they interact with existing socioeconomic landscape and inequalities (such as class), with informal solidarity networks, including kinship, neighborhood and religious groups, as well as formal social protection schemes? Which economic subjectivities, and forms of responsibility for health and care are being pursued or fostered in this process? Which possibilities do they foster, and which vulnerabilities do they exploit?
Accepted papers:
Session 1 Thursday 1 April, 2021, -Paper short abstract:
This paper demonstrates how universality has become a focal point of health activism in the UK, thus leading to the building of new solidarities and a putative class consciousness.
Paper long abstract:
This paper demonstrates how universality has become a focal point of health activism in the UK, thus leading to the building of new ties between social groups.
The paper is based on ethnographic fieldwork with people campaigning against cuts and privatisation in the NHS, the UK’s public healthcare system. In contrast with countries that do not have pre-existing free, comprehensive healthcare services, UK healthcare activists object to insurance-based schemes, which they see as representative of privatised health systems. Such systems are rendered as inefficient, unfair and low quality, serving as a foil against which to compare the (imagined) goods of the NHS: universal, free and comprehensive.
The Tory government undermined these goods with its “hostile environment” policies, introduced from 2012 onwards. Charges were introduced for people deemed ineligible for free healthcare, officially described as “overseas visitors” and popularly dubbed “healthcare tourists”. As well, a healthcare surcharge was introduced for anyone applying for a UK work visa. This surcharge effectively functioned as an insurance premium, payable on top of any taxes paid by migrants.
These policies formed part of a narrative that the reason the NHS was deteriorating was because of uncontrolled immigration. Thus the Tory government moulded the popularity of free healthcare to a logic of exclusivity. Activists used the NHS value of universality as a rallying point to reject this logic. They defined their campaigns according to a unity of interests between themselves and migrants. Thus they built alliances across occupational groups, ethnicities and nationalities, thus building new solidarities.
Paper short abstract:
This paper explores the new forms of solidarity and care that are forged, maintained and reinforced at the intersection of the Kenya’s national health insurance, formal and informal social protection mechanisms and mobile/digital technology.
Paper long abstract:
Over the last decade, the Kenya government has continued to expand the country’s national health insurance (National Hospital Insurance Fund) to include those in the informal sector as well as providing free maternal health care and health insurance subsidies for the vulnerable populations such as the beneficiaries of cash transfer schemes and elderly persons. Although the national health insurance is framed within the language of financial protection and state responsibility to care, the health insurance does not offer reliable access to healthcare. In many cases, patients and health workers navigate both mundane and persistent complexities, disappointments, frustrations and failure of the national health insurance through different solidarities: ethnic and kinship based, and patronage networks. The increasing digitization of Kenya’s economy through mobile money technology over the last decade has transformed these forms of solidarities/networks of care in different ways. Based on ethnographic fieldwork in Kenya, this paper explores the new forms of solidarity and care that are forged, maintained and reinforced at the intersection of the country’s national health insurance, formal and non-formal social protection mechanisms, and mobile/digital technology.
Paper short abstract:
A common reason for being uninsured is not having money. But what does this really mean? My ethnographic research in Vietnam during the country's universal health coverage campaign finds five demotivating factors related to obligations to informal solidarity networks and economic subjectivities.
Paper long abstract:
Cost is a well-established barrier to health insurance uptake. Although iterations of the phrase “I don’t have any money to buy health insurance” are pervasive in research on the determinants of enrollment, its meaning is not universal. Through ethnographic immersion in Vinh Long Province, Vietnam and 34 semi-structured interviews collected from August 2015-September 2016, I show that being uninsured is not merely about the financial cost of an insurance card. Instead, the use of money signals “anticipatory activities,” which refer to projects undertaken in the service of a projected future. If participation in insurance is fundamentally about planning for the future, then people weighed the risk management aspect of insurance against other more pressing anticipatory activities. Cash facilitated one’s ability to adjust to rapidly changing circumstances engendered by Vietnam’s ongoing marketization and global integration. For informal sector workers in this rural district, the value of health insurance was judged against five primary anticipatory activities where cash had instrumental and cultural dimensions: anticipating care responsibilities following the life course, anticipating changing economic and environmental risks, cultivating relationships as a form of anticipation, anticipating uncertain health vulnerabilities, and anticipating the inequalities of the health care system. By bringing attention to how anticipation is articulated in financial and health-seeking practices, I show how my interlocutors view their decision to remain uninsured as morally worthwhile. This study moves beyond utilitarian frameworks for understanding the uninsured. It also advances the anthropological agenda to study the “social life of health insurance” across the globe.
Paper short abstract:
2018 ushered in a state declaration and hope for Universal Health Coverage in Kenya. This paper highlights the possibilities but also the limits of health insurance, and the importance of kinship and social networks in navigating care.
Paper long abstract:
2018 ushered in a state declaration and hope for Universal Health Coverage in Kenya. Years of structural adjustments, mounting costs of health care, the institution of ‘user fees’ and rising rates of chronic illnesses mean that ordinary Kenyans have little control over their health and healthcare costs. However, the universal health coverage agenda reignited hope, desire and claims of public health control for the ordinary citizens as it promised their inclusion into the insurance fold offering better access and affordability of necessary care. At the national level, the World Bank financed social health insurance experimentations in four select counties during 2018 and 2019, which are still ongoing. Elsewhere, county leaders experimented with specific premium based insurance schemes. Various health sector actors, whether for-profit and not-for-profit, made claims and spearheaded efforts to bring the uninsured into the insurance fold, positioning themselves as compassionate caregivers, dependable networks and welfare champions to the poor and vulnerable or to the off grid populations. This context of renewed hope for the expansion of health insurance arise alongside efforts to ‘restructure’ sub-Saharan’s oldest health insurer as the ideal public health purchaser. Drawing from 12 months ethnographic fieldwork in Kenya. This paper highlights the possibilities but also the limits of health insurance, and the importance of kinship and social networks in navigating care. It also attends to the politics of value and strategic inclusion emerging among uninsured publics and actors, through following some Kenyan families seeking redress of emerging and prolonged health crises for loved ones.