Thursday, April 18, 2024

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


Authors:

Sowmini G Prasad
Anjali Nambiar

Introduction

Common well being protection (UHC) is a well being coverage purpose for a lot of growing international locations, together with India. UHC implies 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 realize this purpose, 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 offer such entry to poorer populations (Bhat et al., 2017). Nevertheless, for a lot of of those packages, the street to realizing these targets and translating them into improved well being outcomes is riddled with a number of challenges.

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

When considered 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 transferring to a extra built-in mannequin of healthcare provision might assist (Ashraf et al., 2021), on this weblog put up, 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 carefully 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. Not like an arbitrary group of individuals, a neighborhood represents a bunch with shared pursuits, objectives, experiences, values, language, faith, and so on. For instance, migrant staff might turn 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 deliver folks collectively, and interactions amongst them can result in particular person and group bonds growing. 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 might work together with one another ceaselessly on account of being on the similar job web site, or an occasion could also be organized to deliver staff with a shared ethnicity collectively. Each types of interactions, repeated over a interval, can strengthen bonds, create a way of belonging and step by step result in a close-knit neighborhood forming.

Inside communities, member interactions, each deliberate and unplanned, might evolve into rituals that turn into markers of belongingness but in addition act to strengthen present bonds. Right here, rituals consult with behaviours and actions that neighborhood members commonly show or comply with. Within the earlier instance of migrant staff, an instance of a ritualmay be staff coming collectively as soon as each day to arrange and share meals. Over a interval, such rituals and the areas for interactions they create enable members to share their on a regular basis lives and experiences, producing a way of belief, reciprocity, and solidarity among the many members. These points are what we consult with 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). Nevertheless, past enrolment into such packages, the potential of social capital in mitigating most of the different challenges shoppers might face with medical health insurance packages stays largely unexplored. Whereas the discourse round social capital additionally cautions towards its downsides (Moore & Kawachi, 2017; Donfouet & Mahieu, 2012), we prohibit our focus on this weblog put up 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 means of which social capital will be put to work to handle most of the challenges shoppers might face in successfully benefitting from medical health insurance packages.

  1. Enrolment in a medical health insurance program

A client’s resolution to enrol in a medical health insurance program could also be affected by a number of elements, chief amongst that are consciousness of 1’s healthcare wants, consciousness and appreciation of medical health insurance, and behavioural biases related to looking for healthcare and medical health insurance (Ashraf & Nambiar, 2021). Even when these challenges have been resolved, shoppers would possibly nonetheless have program-specific issues, corresponding to apprehensions relating to the potential misuse of premium cash. We see a task for social capital in addressing such issues. As an illustration, 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 means of 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 probably as a system strikes nearer to providing the complete spectrum of companies, or on the very least, a mixture of preventive care and medical recommendation relating to, firstly, the considered use of medicines and, secondly, acceptable ranges of secondary or tertiary care. In India, nevertheless, an built-in and holistic method to healthcare is usually absent as a result of preponderance of indemnity insurance coverage. Due to this fact, Indian shoppers don’t usually search preventive care, and after they require hospitalization, they usually face challenges in selecting and accessing acceptable care. Right here too, then, we see a crucial position for social capital. As an illustration, interactions with trusted neighborhood well being staff and leaders might persuade members to avail acceptable preventive healthcare. Additional, belief and emotions of solidarity might immediate members to help one another in accessing time-sensitive details about healthcare suppliers lined below an insurance coverage program throughout well being shock.

  1. Claims settlement course of

In insurance coverage packages that provide cashless remedy, shoppers ideally don’t incur out-of-pocket bills for remedy. Nevertheless, the place insurance coverage packages pay retrospectively for remedy bills, shoppers want to hunt reimbursement by means of 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, shoppers will discover the claims settlement course of to be cumbersome and difficult. Right here, social capital might enable 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, shoppers might endure grievances that want redressal. These might embody 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 information of grievance redress mechanisms and entry to needed data might make the redress course of difficult. Group bonds could also be leveraged to disseminate data on submitting a grievance, to offer periodic updates on the development of grievance processing, and to make neighborhood members conscious of obtainable avenues for escalation.

  1. Renewal resolution

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 decide out. Broadly, two elements might affect this resolution. One, the absence of a well being shock through the earlier subscription interval might trigger shoppers to query the deserves of renewing. Two, for shoppers who skilled a well being shock through the earlier subscription interval, their expertise of using healthcare by means of this system can turn into dispositive.

Social capital might help deal with a few of these issues. As an illustration, interactions with different members who’ve skilled a well being shock and availed of healthcare below an insurance coverage program might persuade members who didn’t have to make use of the companies to however renew. Additional, neighborhood leaders may very well 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 put up, we now have tried to map shoppers’ 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 manner, some rituals that deliver neighborhood members collectively might have to be formalized. As soon as absolutely developed, this framework can doubtlessly kind a helpful lens to guage medical health insurance packages from a client perspective and help in growing 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). Overview of Group/Mutual-Based mostly Well being Insurance coverage Schemes and Their Function 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-Principle.pdf

Donfouet, H. P. P., & Mahieu, P.-A. (2012). Group-based medical health insurance and social capital: A evaluation. Well being Economics Overview, 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 Elements Have an effect on Voluntary Uptake of Group-Based mostly Well being Insurance coverage Schemes in Low- and Center-Earnings Nations? A Systematic Overview 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

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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/

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[1] Students throughout disciplines view social capital in another way; no single agreed-upon definition exists. Nevertheless, the present discourse extensively credit two sociologists, Pierre Bourdieu and James Coleman, for theorizing the idea. Whereas each think about social capital as a useful resource that emanates from and resides in societal relationships, there are specific variations of their respective conceptualizations. Bourdieu felt that social capital permits particular person entry to assets hitherto unavailable, the absence of which deprives one of many similar. Then again, Coleman regarded social capital as a high quality of the collective that garners the entire group larger entry to assets 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 buyer journey phases, processes concerned at every stage, and their sequence within the journey might differ 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 Shoppers’ Expertise with Well being Insurance coverage? Retrieved from Dvara Analysis.

MLA

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

Chicago

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

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