2018 Theses Doctoral
The Social Life of Health Insurance Temporality, Care, and the Politics of Financing Health in Rural Vietnam
Health insurance stands at the center of global debates on how nations can ensure equitable access to health care, especially for countries like Vietnam whose integration into the global economy has boosted economic development but intensified social inequality. When health insurance is promoted to low- to middle-income country contexts by development agencies such as the World Health Organization and the World Bank, what embedded cultural values accompany this? How do locally specific historical, political, and ethical concepts for managing vulnerability and uncertainty shape public understanding of insurance? To date, empirical research on health insurance’s impact has tended to examine its relation to health outcomes, service utilization patterns, or health care delivery rather than its cultural effects. As health insurance initiatives have expanded to at least 27 countries within the last decade, the universality of insurance’s value to local populations cannot be assumed. This ethnographic research investigates the cultural mediators and effects as a factor for understanding public responses to health insurance. It documents how this financial technology is transforming knowledge about how to care and manage health vulnerability. With the support of international organizations, the Vietnamese government began its universal health insurance enrollment campaign in 2015. State officials, however, identify the “Vietnamese habit” of purchasing insurance only when ill as both a technical and cultural problem to achieving universal coverage. To better understand this process, I investigated how strategies to “change the mindset of citizens” were deployed by state media and personnel, and then actively resisted, incorporated, or transformed by community members. The study took place in Vinh Long Province, an agricultural area in the Mekong Delta with one of the highest uninsured rates in the country. I conducted twelve months of ethnographic research, including 60 semi-structured interviews with community members, health insurance professionals, and health care professionals; and extended participant observation in government health facilities, insurance offices, and the homes of community members. The study analyzes the social consequences of new health insurance initiatives, the temporality of care, everyday dimensions of health care uncertainty, and their relevance to concerns within medical anthropology. I demonstrate how Vietnam’s insurance reform affected the terms through which people understood their social relations and risk subjectivities. By detailing the dynamic processes of a health insurance campaign aimed at changing health behaviors, the research reveals how financial policies are not value neutral. Rather, they reshape local moral worlds, social relations, and practices for managing uncertainty in late socialist Vietnam.
This item is currently under embargo. It will be available starting 2020-07-23.
- Academic Units
- Sociomedical Sciences
- Thesis Advisors
- Sharp, Lesley Alexandra
- Ph.D., Columbia University