Accepted Paper
Paper short abstract
Where health is funded privately, payments for healthcare easily lead to personal indebtedness yet there are significant knowledge gaps especially in terms of experiences from the majority world. Here we start to consider what we know and work towards a preliminary research agenda.
Paper long abstract
Where health is funded privately, payments for healthcare easily lead to personal indebtedness. Debts for health are a phenomenon that is well-researched for the USA and to some extent other higher-income countries, but the majority world largely remains terra incognita. Yet qualitative evidence, such as from financial inclusion research, suggests health expenses are crucial to why many people become entrapped in debt. Meanwhile, recent scholarship notes “structural changes that are turning healthcare into a playing field for capitalist actors”, suggesting systemic links between financialisation, profit-making, rising health expenses, and indebtedness. As research from other issue-fields suggests, when the public provision of basic services declines or is politically eschewed in favour of profit-oriented and financialised providers, households face greater debt and risk burdens.
Our paper offers a preliminary attempt to crack open the black box regarding health-related indebtedness in the majority world, reviewing some of the key issues and challenges and identifying research gaps. We consider what global evidence tells us about the causes, manifestations, and consequences of medical indebtedness, and the possible links between these. For example, when publicly funded healthcare erodes and new for-profit providers, blended finance arrangements, or outsourcing models enter – how does this affect patients and their families? How does health-related indebtedness manifest – e.g. different types of debt, treatment inequalities, or even hospital incarceration – and how do people cope? In turn, health-related indebtedness may have consequences such as delayed treatment-seeking, worsened gender inequalities, descent into debt traps, while creating political and systemic-level repercussions.
Health debts and health financialisation in the majority world