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.