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Dvara Analysis Weblog | Can Leveraging Social Capital Improve Customers’ Expertise with Well being Insurance coverage?


Authors:

Sowmini G Prasad
Anjali Nambiar

Introduction

Common well being protection (UHC) is a well being coverage aim for a lot of creating international locations, together with India. UHC signifies that “all folks have entry to the complete vary of high quality well being companies they want, when and the place they want them, with out monetary hardship” (World Financial institution, n.d.). To attain this aim, governments worldwide, together with India, are designing medical health insurance packages that present various ranges of twin entry, i.e., healthcare and monetary safety (Forgia & Nagpal, 2012). Additional, a number of smaller and focused community-based medical health insurance (CBHI) packages have taken form to supply such entry to poorer populations (Bhat et al., 2017). Nonetheless, for a lot of of those packages, the highway to realizing these targets and translating them into improved well being outcomes is riddled with a number of challenges.

These challenges could originate from each the demand and provide sides, in the end impacting the buyer. As an instance, challenges on the demand aspect could embrace behavioural biases impeding insurance coverage uptake (Ashraf et al., 2021). On the provision aspect, the design of medical health insurance packages might also give rise to sure challenges. As an example, the kind of incentives supplied to healthcare suppliers could have an effect on the supply of healthcare companies, corresponding to beneath or over-provisioning, denial of companies, or the standard of healthcare companies offered (Ashraf et al., 2021).

When seen from a client’s perspective, these challenges manifest at totally different phases of their journey with a medical health insurance program, starting from the choice to enrol in a program and ending on the renewal stage. Whereas tweaks to the design of the medical health insurance program or shifting to a extra built-in mannequin of healthcare provision could assist (Ashraf et al., 2021), on this weblog publish, we discover the position that social capital can play in circumventing a few of these challenges.

Social Capital and Well being Insurance coverage

The idea of social capital is intently linked to the idea of a neighborhood. Social capital, the place it exists, will be traced to the existence of a neighborhood and social relationships amongst members of such a neighborhood. In contrast to an arbitrary group of individuals, a neighborhood represents a bunch with shared pursuits, targets, experiences, values, language, faith, and many others. For instance, migrant staff could develop into a part of a neighborhood at their office due to shared ethnicity, corresponding to coming from the identical Indian state and talking the identical language. Such commonalities can carry folks collectively, and interactions amongst them can result in particular person and group bonds creating. We will think about such particular person and group interactions occurring as a part of on a regular basis lives or as a part of deliberate makes an attempt to create a neighborhood. Within the earlier instance, migrant staff could work together with one another regularly on account of being on the similar job web site, or an occasion could also be organized to carry staff with a shared ethnicity collectively. Each types of interactions, repeated over a interval, can strengthen bonds, create a way of belonging and progressively result in a close-knit neighborhood forming.

Inside communities, member interactions, each deliberate and unplanned, could evolve into rituals that develop into markers of belongingness but in addition act to strengthen current bonds. Right here, rituals seek advice from behaviours and actions that neighborhood members usually show or observe. Within the earlier instance of migrant staff, an instance of a ritualmay be staff coming collectively as soon as day-after-day to arrange and share meals. Over a interval, such rituals and the areas for interactions they create permit members to share their on a regular basis lives and experiences, producing a way of belief, reciprocity, and solidarity among the many members. These features are what we seek advice from as social capital[1].

In medical health insurance, the idea of social capital has been acknowledged as a key determinant of the success of CBHI packages which are sometimes voluntary and require prepayment to entry companies. Specifically, emotions of belief and solidarity have been discovered to considerably affect the willingness of neighborhood members to enrol (Donfouet & Mahieu, 2012; Dror et al., 2016; Negera & Abdisa, 2022). Nonetheless, past enrolment into such packages, the potential of social capital in mitigating lots of the different challenges customers could face with medical health insurance packages stays largely unexplored. Whereas the discourse round social capital additionally cautions in opposition to its downsides (Moore & Kawachi, 2017; Donfouet & Mahieu, 2012), we prohibit our focus on this weblog publish to social capital as an enabler.

A Shopper’s Journey with Well being Insurance coverage

A client’s journey with a medical health insurance program could also be broadly divided into 5 phases, as talked about under. We argue that there’s scope at every of those phases for leveraging social capital and the rituals integral to producing and sustaining it[2]. We determine neighborhood members, neighborhood well being staff, and neighborhood leaders as related stakeholders on this context. Common interactions amongst them, whether or not formal or casual, can present potential avenues by which social capital will be put to work to handle lots of the challenges customers could face in successfully benefitting from medical health insurance packages.

  1. Enrolment in a medical health insurance program

A client’s choice to enrol in a medical health insurance program could also be affected by a number of components, chief amongst that are consciousness of 1’s healthcare wants, consciousness and appreciation of medical health insurance, and behavioural biases related to in search of healthcare and medical health insurance (Ashraf & Nambiar, 2021). Even when these challenges have been resolved, customers may nonetheless have program-specific considerations, corresponding to apprehensions relating to the potential misuse of premium cash. We see a task for social capital in addressing such considerations. As an example, when neighborhood members work together with these in the neighborhood which have skilled medical health insurance advantages, they could come to see the worth of medical health insurance and be persuaded to enrol in a program.

  1. Utilization of healthcare companies

Accessing healthcare by the insurance coverage program can both contain solely inpatient care (as in lots of indemnity packages) or the complete spectrum of companies encompassing preventive care, major care, and hospitalization (as in managed care packages) (Ashraf, 2021). It ought to be apparent that higher well being outcomes are extra doubtless as a system strikes nearer to providing the complete spectrum of companies, or on the very least, a mix of preventive care and medical recommendation relating to, firstly, the even handed use of medicines and, secondly, acceptable ranges of secondary or tertiary care. In India, nevertheless, an built-in and holistic strategy to healthcare is usually absent as a result of preponderance of indemnity insurance coverage. Due to this fact, Indian customers don’t typically search preventive care, and once they require hospitalization, they usually face challenges in selecting and accessing acceptable care. Right here too, then, we see a important position for social capital. As an example, interactions with trusted neighborhood well being staff and leaders could persuade members to avail acceptable preventive healthcare. Additional, belief and emotions of solidarity could immediate members to help one another in accessing time-sensitive details about healthcare suppliers lined beneath an insurance coverage program throughout well being shock.

  1. Claims settlement course of

In insurance coverage packages that provide cashless therapy, customers ideally don’t incur out-of-pocket bills for therapy. Nonetheless, the place insurance coverage packages pay retrospectively for therapy bills, customers want to hunt reimbursement by a claims settlement course of that will contain a number of interactions with an insurance coverage program’s administration. With out consciousness of and entry to needed data, customers will discover the claims settlement course of to be cumbersome and difficult. Right here, social capital could permit neighborhood members to help one another, making the method extra accessible, less complicated, and fewer useful resource intensive for the aggrieved member.

  1. Grievance redress mechanism

From their expertise of accessing and using healthcare companies, customers could undergo grievances that want redressal. These could embrace denial of healthcare, delay in receiving healthcare, poor high quality of companies acquired, overbilling, and even issues with the claims settlement course of. Once more, as with the claims settlement course of, a lack of knowledge of grievance redress mechanisms and entry to needed data could make the redress course of difficult. Group bonds could also be leveraged to disseminate data on submitting a grievance, to supply periodic updates on the development of grievance processing, and to make neighborhood members conscious of obtainable avenues for escalation.

  1. Renewal choice

On the finish of a client’s journey with a medical health insurance program (in a single membership cycle), they could select to resume their enrolment or choose out. Broadly, two components could affect this choice. One, the absence of a well being shock in the course of the earlier subscription interval could trigger customers to query the deserves of renewing. Two, for customers who skilled a well being shock in the course of the earlier subscription interval, their expertise of using healthcare by this system can develop into dispositive.

Social capital might help handle a few of these considerations. As an example, interactions with different members who’ve skilled a well being shock and availed of healthcare beneath an insurance coverage program could persuade members who didn’t have to make use of the companies to nonetheless renew. Additional, neighborhood leaders might be actively concerned in capturing and relaying client suggestions to program heads inspiring client confidence within the scheme regardless of remoted incidences of poor companies.

Conclusion

The position of social capital in medical health insurance has been explored beforehand however to a restricted extent from a client’s perspective. On this weblog publish, we now have tried to map customers’ journey with medical health insurance packages, determine potential challenges they could face in successfully benefitting from the packages, and offered examples of how social capital will be put to work to beat these challenges. To successfully leverage social capital on this approach, some rituals that carry neighborhood members collectively could should be formalized. As soon as absolutely developed, this framework can probably kind a helpful lens to judge medical health insurance packages from a client perspective and assist in creating community-driven options to client challenges.

References

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Ashraf, H., Ghosh, I., Kumar, N., Nambiar, A., & Prasad, S. (2021, June 28). Pathways to Reimagining Industrial Well being Insurance coverage. Dvara Analysis Weblog. https://www.dvara.com/analysis/weblog/2021/06/28/pathways-to-reimagining-commercial-health-insurance/

Ashraf, H., & Nambiar, A. (2021, November). Demand for Well being Insurance coverage. Dvara Analysis Weblog. https://www.dvara.com/analysis/weblog/2021/11/16/demand-for-health-insurance/

Bhat, R., Menezes, L., & Avila, C. (2017). Assessment of Group/Mutual-Primarily based Well being Insurance coverage Schemes and Their Position in Strengthening the Monetary Safety System in India. USAID. https://www.hfgproject.org/review-community-mutual-based-health-insurance-schemes-role-strengthening-financial-protection-system-india/

Claridge, T. (2017). Introduction to Social Capital. https://www.socialcapitalresearch.com/wp-content/uploads/edd/2018/08/Introduction-to-Social-Capital-Concept.pdf

Donfouet, H. P. P., & Mahieu, P.-A. (2012). Group-based medical health insurance and social capital: A evaluation. Well being Economics Assessment, 2(1), 5. https://doi.org/10.1186/2191-1991-2-5

Dror, D. M., Hossain, S. A. S., Majumdar, A., Pérez Koehlmoos, T. L., John, D., & Panda, P. Okay. (2016). What Components Have an effect on Voluntary Uptake of Group-Primarily based Well being Insurance coverage Schemes in Low- and Center-Earnings International locations? A Systematic Assessment and Meta-Evaluation. PloS One, 11(8), e0160479. https://doi.org/10.1371/journal.pone.0160479

Forgia, G. L., & Nagpal, S. (2012). Authorities-Sponsored Well being Insurance coverage in India: Are You Lined? World Financial institution Publications – Books. https://concepts.repec.org//b/wbk/wbpubs/11957.html

Fukuyama, F. (2002). Social Capital and Growth: The Coming Agenda. SAIS Assessment (1989-2003), 22(1), 23–37.

Kawachi, I., Subramanian, S. V., & Kim, D. (2008). Social Capital and Well being. In I. Kawachi, S. V. Subramanian, & D. Kim (Eds.), Social Capital and Well being (pp. 1–26). Springer. https://doi.org/10.1007/978-0-387-71311-3_1

Lin, N. (2001). Constructing a Community Concept of Social Capital. In Social Capital. Routledge.

Mladovsky, P., & Mossialos, E. (2008). A Conceptual Framework for Group-Primarily based Well being Insurance coverage in Low-Earnings International locations: Social Capital and Financial Growth. World Growth, 36(4), 590–607. https://doi.org/10.1016/j.worlddev.2007.04.018

Moore, S., & Kawachi, I. (2017). Twenty years of social capital and well being analysis: A glossary. J Epidemiol Group Well being, 71(5), 513–517. https://doi.org/10.1136/jech-2016-208313

Nambiar, A. (2021, March 18). Group-based Well being Insurance coverage: The VimoSEWA Case. Dvara Analysis Weblog. https://www.dvara.com/analysis/weblog/2021/03/18/community-based-health-insurance-the-vimosewa-case/

Negera, M., & Abdisa, D. (2022). Willingness to pay for neighborhood based mostly medical health insurance scheme and components related to it amongst households in rural neighborhood of South West Shoa Zone, Ethiopia. BMC Well being Companies Analysis, 22(1), 734. https://doi.org/10.1186/s12913-022-08086-z

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[1] Students throughout disciplines view social capital in another way; no single agreed-upon definition exists. Nonetheless, the present discourse broadly credit two sociologists, Pierre Bourdieu and James Coleman, for theorizing the idea. Whereas each contemplate social capital as a useful resource that emanates from and resides in societal relationships, there are particular variations of their respective conceptualizations. Bourdieu felt that social capital permits particular person entry to sources hitherto unavailable, the absence of which deprives one of many similar. Alternatively, Coleman regarded social capital as a top quality of the collective that garners the entire group higher entry to sources or goodwill (Claridge, 2017). Ultimately it was a political scientist, Robert Putnam, who popularised the time period and aggregated it to the belief that facilitates interpersonal cooperation.

[2] The patron journey phases, processes concerned at every stage, and their sequence within the journey could range based mostly on the insurance coverage coverage and the nation context.


Cite this weblog:

APA

Prasad, S. G., & Nambiar, A. (2023). Can Leveraging Social Capital Improve Customers’ Expertise with Well being Insurance coverage? Retrieved from Dvara Analysis.

MLA

Prasad, Sowmini G and Anjali Nambiar. “Can Leveraging Social Capital Improve Customers’ Expertise with Well being Insurance coverage?” 2023. Dvara Analysis.

Chicago

Prasad, Sowmini G, and Anjali Nambiar. 2023. “Can Leveraging Social Capital Improve Customers’ Expertise with Well being Insurance coverage?” Dvara Analysis.

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