The Social Life of Health Insurance in Low‐ to Middle‐income Countries: An Anthropological Research Agenda

Abstract

The following article identifies new areas for engaged medical anthropological research on health insurance in low- and middle-income countries (LMICs). Based on a review of the literature and pilot research, we identify gaps in how insurance is understood, administered, used, and abused. We provide a historical overview of insurance as an emerging global health panacea and then offer brief assessments of three high-profile attempts to provide universal health coverage. Considerable research on health insurance in LMICs has been quantitative and focused on a limited set of outcomes. To advance the field, we identify eight productive areas for future ethnographic research that will add depth to our understanding of the social life and impact of health insurance in LMICs. Anthropologists can provide unique insights into shifting health and financial practices that accompany insurance coverage, while documenting insurance programs as they evolve and respond to contingencies.

Health insurance in India: what do we know and why is ethnographic research needed

“…According to Dao and Nichter (2015), ethnographic investigations of the 'social life of insurance' are a necessary complement to the quantitative studies conducted to date. Toward that end, fieldwork was conducted in Kerala to shed light on both public impressions of health insurance and the manner in which these perceptions influence the engagement of insurance, and how insurance influences healthcare providers' practices.…”

“…This paper examines challenges to implementing health insurance in India and makes a case for anthropological studies of the social life of insurance schemes (Dao and Nichter 2015) as a means of providing fresh insights to the emerging interdisciplinary field of health policy and service research (Gilson et al 2011;Mills 2012;Hafner and Shiffman 2013). Medical anthropologists and anthropologists of global health and development have long been investigating the expansion of biomedical technologies, including issues of access and affordability (Lock and Nguyen 2010), and of health-related intervention programs (e.g.…”

“…In the United States of America (USA), anthropologists have only recently been called upon to pay attention to this topic, as health reform has become a pressing political issue (Horton et al 2014). A similar appeal has been made for anthropologists working in low-and middle-income countries such as Vietnam and Thailand where the idea of UHC has been pushed for by international bodies such as the World Health Organization (Dao and Nichter 2015). When health policies are encouraged by national or international, public or private institutions, a so-called 'implementation gap' may arise.…”

Thrifting for More: Savings and Aspirations in Health Care Sharing Ministries after the Affordable Care Act

“…Even though HCSMs are not exactly insurance, a consideration of how and to what ends thrift is experienced in the HCSM world today contributes to the emergent subfield in medical anthropology known as the “anthropology of insurance” (Dao and Mulligan ). Ethnographers have shown how access to and payment for insurance is experienced “on‐the‐ground” and offered nuanced depictions of how prominent health policy ideas of risk, responsibility, and choice are actually lived out (see e.g., Dao and Nichter ; Lamphere ; Mulligan ; Mulligan and Castañeda ). This subfield has also shed light on how Americans seek out or withdraw from insurance in the context of various life circumstances, including job status (Fletcher ), family caretaking roles (Mulligan ), class and gender (Brunson ), geography (Sered and Fernandopulle ), among others.…”

Balancing satisfaction, balancing health

“…Providers' behaviour (e.g. moral hazards) and trust relations between stakeholders are among the key anthropological factors which potentially impact the sustainability of health insurance systems (Dao & Nichter, 2016). This dissertation could contribute to understanding those socio-cultural factors in the health system of Bangladesh for consideration in future health financing reforms.…”