The payment and milieu of mutual aid: the National Health Insurance Scheme and multiple cares in southern Ghana
Akinori Hamada (National Museum of Ethnology, Japan)
Paper short abstract:
In 2004, the National Health Insurance Scheme (NHIS) was introduced in Ghana. This health insurance, or anonymous mutual aid, not only replaces and undermines some face-to-face mutual aid practices but also entails others. This paper explores how this new technology impacts sociality.
Paper long abstract:
In 2004, the National Health Insurance Scheme (NHIS) was introduced in Ghana, and the scheme has since become widely used. This paper examines how this new technology of paying medical fees impacts the sociality and ecology of care. Previous studies in the sociology of insurance have mainly explored chronological change and emphasize that insurance has atomizing effects and erodes face-to-face mutual aid practices. However, when closely examined, the coexistence of several types of mutual aid practices can be found, and such practices shape milieu through not only their juxtaposition but also sequentially relation. This milieu may be called an ecology of care for paying medical fees. Health insurance in Ghana is rooted in medical policy history. From independence in 1958, a free medical service policy meant patients did not pay any medical fees. In this era, the government cared for people's health economically. Embracing structural adjustment policy in 1985, however, patients were confronted with the need to afford medical fees. However, people did not necessarily pay these fees by themselves, but used face-to-face mutual aid through kinship and friendship ties. Finally, as an extension of this neoliberal policy, Ghana's government introduced health insurance as a new method of payment. This health insurance, which is anonymous mutual aid practice, not only replaces and undermines face-to-face mutual aid practices but also entails other types of mutual aid practices. Describing the milieu of mutual aid practices, this paper explores how this new technology impacts the sociality of the people concerned.