University of Edinburgh, Edinburgh, UK.
University of Pennsylvania, Philadelphia, PA, USA.
Anthropol Med. 2023 Dec;30(4):380-393. doi: 10.1080/13648470.2023.2291738. Epub 2024 Feb 8.
Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued.
自 21 世纪初以来，印度引入了数百项政府资助的健康保险（GFHI）计划。这些计划旨在防止贫困家庭发生灾难性的医疗支出。通过 GFHIs，政策制定者希望在自由化的医疗保健市场中调动私人消费者的决策能力。政策制定者呼吁患者通过需求优化供应，充当医疗保健价值的“共同创造者”。基于我们在印度南部对保险用户进行的长期民族志实地研究，我们认为 GFHIs 失败了，因为人们对保险的价值的体验方式大不相同，而这与政策制定者假设的他们对保险的价值观念只有部分重叠。此外，健康保险的空洞承诺可能令人感到非常沮丧，以至于参保实际上会让人感到自己的价值被贬损。
