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Introduction
Common well being protection (UHC) is a well being coverage objective for a lot of growing international locations, together with India. UHC implies that “all folks have entry to the total vary of high quality well being providers they want, when and the place they want them, with out monetary hardship” (World Financial institution, n.d.). To attain this objective, governments worldwide, together with India, are designing medical insurance applications 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 insurance (CBHI) applications have taken form to supply such entry to poorer populations (Bhat et al., 2017). Nonetheless, for a lot of of those applications, 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, finally impacting the patron. As an instance, challenges on the demand facet could embody behavioural biases impeding insurance coverage uptake (Ashraf et al., 2021). On the availability facet, the design of medical insurance applications may additionally 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 providers, equivalent to underneath or over-provisioning, denial of providers, or the standard of healthcare providers supplied (Ashraf et al., 2021).
When considered from a client’s perspective, these challenges manifest at totally different levels of their journey with a medical 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 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 gaggle with shared pursuits, targets, experiences, values, language, faith, and so on. For instance, migrant employees could develop into a part of a neighborhood at their office due to shared ethnicity, equivalent 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 are able to 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 employees could work together with one another continuously on account of being on the identical job web site, or an occasion could also be organized to deliver employees with a shared ethnicity collectively. Each types of interactions, repeated over a interval, can strengthen bonds, create a way of belonging and steadily 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 present bonds. Right here, rituals seek advice from behaviours and actions that neighborhood members often show or comply with. Within the earlier instance of migrant employees, an instance of a ritualmay be employees coming collectively as soon as each day to organize 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 features are what we seek advice from as social capital[1].
In medical insurance, the idea of social capital has been acknowledged as a key determinant of the success of CBHI applications which are sometimes voluntary and require prepayment to entry providers. Particularly, 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 applications, the potential of social capital in mitigating lots of the different challenges shoppers could face with medical insurance applications 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 Client’s Journey with Well being Insurance coverage
A client’s journey with a medical insurance program could also be broadly divided into 5 levels, as talked about under. We argue that there’s scope at every of those levels for leveraging social capital and the rituals integral to producing and sustaining it[2]. We establish neighborhood members, neighborhood well being employees, 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 deal with lots of the challenges shoppers could face in successfully benefitting from medical insurance applications.
- Enrolment in a medical insurance program
A client’s choice to enrol in a medical 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 insurance, and behavioural biases related to looking for healthcare and medical insurance (Ashraf & Nambiar, 2021). Even when these challenges had been resolved, shoppers would possibly nonetheless have program-specific issues, equivalent to apprehensions relating to the potential misuse of premium cash. We see a job for social capital in addressing such issues. As an example, when neighborhood members work together with these locally which have skilled medical insurance advantages, they could come to see the worth of medical insurance and be persuaded to enrol in a program.
- Utilization of healthcare providers
Accessing healthcare by means of the insurance coverage program can both contain solely inpatient care (as in lots of indemnity applications) or the whole spectrum of providers encompassing preventive care, major care, and hospitalization (as in managed care applications) (Ashraf, 2021). It ought to be apparent that higher well being outcomes are extra possible as a system strikes nearer to providing the whole spectrum of providers, 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, nonetheless, an built-in and holistic strategy to healthcare is usually absent because of the 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 example, interactions with trusted neighborhood well being employees 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 underneath an insurance coverage program throughout well being shock.
- Claims settlement course of
In insurance coverage applications that provide cashless therapy, shoppers ideally don’t incur out-of-pocket bills for therapy. Nonetheless, the place insurance coverage applications pay retrospectively for therapy 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 crucial info, shoppers will discover the claims settlement course of to be cumbersome and difficult. Right here, social capital could enable neighborhood members to help one another, making the method extra accessible, easier, and fewer useful resource intensive for the aggrieved member.
- Grievance redress mechanism
From their expertise of accessing and using healthcare providers, shoppers could undergo grievances that want redressal. These could embody denial of healthcare, delay in receiving healthcare, poor high quality of providers 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 crucial info could make the redress course of difficult. Neighborhood bonds could also be leveraged to disseminate info 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.
- Renewal choice
On the finish of a client’s journey with a medical 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 shoppers to query the deserves of renewing. Two, for shoppers who skilled a well being shock in the course of the earlier subscription interval, their expertise of using healthcare by means of this system can develop into dispositive.
Social capital may help deal with a few of these issues. As an example, interactions with different members who’ve skilled a well being shock and availed of healthcare underneath an insurance coverage program could persuade members who didn’t have to make use of the providers to nonetheless 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 providers.
Conclusion
The position of social capital in medical insurance has been explored beforehand however to a restricted extent from a client’s perspective. On this weblog publish, we’ve got tried to map shoppers’ journey with medical insurance applications, establish potential challenges they could face in successfully benefitting from the applications, and supplied examples of how social capital will be put to work to beat these challenges. To successfully leverage social capital on this means, some rituals that deliver neighborhood members collectively could should be formalized. As soon as absolutely developed, this framework can doubtlessly kind a helpful lens to judge medical insurance applications from a client perspective and help in growing community-driven options to client challenges.
References
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[1] Students throughout disciplines view social capital in a different way; no single agreed-upon definition exists. Nonetheless, the present discourse extensively credit two sociologists, Pierre Bourdieu and James Coleman, for theorizing the idea. Whereas each take into account 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 assets hitherto unavailable, the absence of which deprives one of many identical. However, 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 patron journey levels, processes concerned at every stage, and their sequence within the journey could differ primarily based 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.