Making markets for development. The consequences of India's new health insurance for experiences of illness and healings among urban and rural poor in India

• Applicant: Professorin Dr. Ursula Rao
• Subject Area: Social and Cultural Anthropology and Ethnology
• Term: from 2014 to 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 246444816

The project investigates the social and cultural consequences of a new health insurance for poor people in India (RSBY, Rashtriya Swasthya Bima Yojana, literally: National Health Insurance Programme). The initiative was launched in 2009 and aims to protect people living below the poverty line from financial ruin during major health crises. For a minimal fee of 30 Rupees (0,42 Euro) eligible participants receive a private health insurance (paid for by the government) that covers in-patient hospital treatment up to an annual maximum of 30.000 Rupees (420 Euro). The insurance gives also poor people privileged access to high quality treatment in private clinics allowing them to avoid long queues in overcrowded government hospitals. Yet, the new benefit comes at a cost. Participants partake in daunting decisions about best usage of a limited resource that can rarely cover all family members and in difficult cases does not pay for the entire treatment, as it is the case with cancer. There is substantial discussion about the structure of the project, its procedures and policies. Yet, so far the social and cultural impact remains largely unexplored.As an anthropological project this study privileges the perspectives of beneficiaries. We will investigate changing approaches to health and healing that follow on from access to the new insurance. How does RSBY change local interpretations of illness and notions of the body? How do negotiations about best usage impact gender relations and how are they entangled with other financial decisions? The comparison of experiences in marginalized rural areas (Chhattisgarh, Orissa) and the urban center of Delhi will facilitate an in-depth analysis of a range of social effects. It will enrich academic debates about cultural re-negotiations of illness and promote critical discussions about novel forms of developmentalism.Today RSBY is the largest insurance scheme worldwide and is celebrated as a milestone in development practice. The anthropological investigation of on-the-ground social practices will facilitate an understanding also of the unexpected consequences, new paradoxes and social conflicts. This is crucial information for further advancement in health market reform. Conceptually, the project will lead discussions about changing experiences of solidarity and social security in expanding markets. How does the health reform change people's perception of and encounters with state institutions and the market? And how does the private public partnership impact on notions of citizenship? The project will advance anthropological debates about new subject positions in an era of market hegemony by studying the appropriation of a significant welfare reform.

• DFG Programme: Research Grants