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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:
- Friday 2 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 Friday 2 April, 2021, -Paper short abstract:
When Brazilians take health insurance companies to court for not authorizing treatments, judges mostly rule that insurance companies have to pay for inflicting moral damage. How are dignity and suffering valued and what does this process reveal about the moralities of private and public healthcare?
Paper long abstract:
When clients take health insurance companies to court for not authorizing treatments or for fraud, they almost always argue that the company violated the client’s human dignity. The judge almost always agrees and rules that the company has to compensate the suffering, loss of human dignity, and moral damage that it has caused. At the same time, a request for moral damage payments is absent from court cases against Brazil's publicly funded health care system (SUS). This implies that suffering means something different when it is caused by a healthcare company then when it is caused by public healthcare institutions. How is this distinction between suffering at the hands of the market and at the hands of the state established? In order to understand this I will examine how the narratives of suffering of patients and their family members take shape within the legal contexts of cases against insurance companies and the state. This shows that healthcare markets empower consumers with human dignity that has both moral ánd monetary value and that lie at the heart of present-day ideological and political struggles in Brazil.
Paper short abstract:
This paper explores the economic logics and notions of solidarity surrounding health insurance in the Netherlands through a case study of excess fees. The paper analyses disputes between insured and complaint handlers and shows how insurance professionals consider themselves guardians of solidarity.
Paper long abstract:
In the Netherlands, universal health coverage operates through a public-private partnership between the Dutch government and privatised health insurers. This partnership raises questions regarding our anthropological understanding of solidarity within the market. How can we trace solidarity in the market and how is it protected? This paper addresses these questions through the case of the mandatory excess fee. This is a fee that individuals pay on top of their insurance premium when they incur healthcare costs. It is an insurance tool, imposed by the government but executed by insurers, that transfers some of the collectively shared costs to individuals. This paper centres on disputes regarding the mandatory excess fee and is based on ten months of ethnographic fieldwork at the complaint department of a privatised health insurer in the Netherlands. Insured complain about the excess fee for diverse reasons: the amount is too high in relation to the care they have received, their medical problem isn’t solved, and other reasons following the economic logic that the costs they have incurred are not appropriate. Complaint handlers, on the other hand, argue that the fee is part of the rules of the Dutch health care system. Complaint handlers apply the rules strictly, believing that, in doing so, they guard solidarity. The paper discusses various complaint letters and other ethnographic material to show how these morally charged encounters between insured and complaint handlers articulate specific economic logics and how they tie into different understandings of solidarity.
Paper short abstract:
The paper connects social class, social mobility and access to health insurance in Kenya. Both middle-class status and health coverage can be short-lived due to high social mobility and income gaps. The descending middle class falls back on out-of-pocket payments and solidarity networks.
Paper long abstract:
This paper develops the connection of social class, social mobility and access to health insurance. The paper presents three cases documented in Kisumu, Kenya, where I conducted ethnographic research on class mobility: One lady in a relatively stable middle-class position argues that her private health coverage indicates her social status. The second lady has always been lower class but maintains close networks with medical doctors and therefore feels well covered. The third lady recently slipped from the middle into the lower class (or floating class) and lost her statutory health coverage due to her social descent. She relies on little pockets of resources and social networks until she can register again for the statutory health insurance. The cases show that health coverage options differ with class, but high social mobility among the Kenyan middle class results in gaps in coverage. Both middle-class status and health insurance coverage can be short-lived due to high social mobility and income gaps. Social descent can lead to pauses in the health coverage, and the descending middle class falls back on out-of-pocket payments and solidarity-based options.
Despite class differences, the three ladies attend the same church and expect mutual help and solidarity in times of hardship from the congregation. The congregation is a mental and material resource the communal orientation of brethren is far from ceasing with class mobility. The three ladies listed the church and their kinship network as their paramount resource; insurances form complementary sources of support to abovementioned paramount ones.
Paper short abstract:
I explore how Kenya’s precarious middle classes navigate a biopolitical landscape of healthcare emerging (before Corona) amidst expanding insurance and medical markets, epidemics of chronic disease, the globalization of medical travel, and the continued evisceration of public healthcare.
Paper long abstract:
In Kenya, a strange biopolitical landscape of healthcare is emerging (or was, before the corona pandemic) at the intersection between expanding insurance and medical markets, a middle class with access to credit, the globalization of medical travel, and the continued evisceration of public healthcare. This paper follows middle-class cancer patients and their families as they navigate these landscapes, as shifting yet precarious geographies of health insurance and medical technologies open up horizons of care just within or beyond reach. I explore trajectories of diagnosis and care that are made possible and foreclosed by Kenya’s national health insurance fund, and how these openings and closures force families into double binds, as the (overwhelming) economic burden of illness ultimately rests on family, kin and their social networks.