Panel Abstract
The Patient Protection and Affordability Act of 2010 was a landmark piece of health care legislation, aiming to increase the affordability of insurance premiums and thereby reduce the number of uninsured Americans. Taking what President Obama has described as a uniquely “American” approach to a national health insurance plan, the Act intends to approximate universal insurance through a continued reliance on employer-based insurance and the expansion of private insurance. Yet as the public debate has fixated primarily on whether the Act would erode the US’ long-standing employer-based system and whether its individual mandate is constitutional, a number of dimensions of the Act and its effects remain under-explored and thus ripe for anthropological analysis. Among these are the ideological assumptions that undergird the Act:  its very specific formulations of “competition” and “choice,” its definition of “insurance” and “risk-pooling,” and its notions of individual, state and corporate responsibility. Moreover, despite the Act’s intention to make health insurance affordable for a broad range of Americans, its lack of emphasis on heavy state regulation and the strength of the health insurance lobby make its success an open question.

Even as the US has relied upon the expansion of private insurance as the linchpin of health care reform, nations in both the global North and South are restructuring their health insurance plans along similar lines. In the face of the mounting cost of caring for an aging population with chronic disease, industrialized nations are attempting to scale back benefits to reduce state costs. Meanwhile, developing nations are experimenting with hybrid forms of insurance—including the expansion of the reach of the state through comprehensive insurance programs while encouraging individual responsibility through conditional cash transfers. This global restructuring of health insurance amounts to no less than a worldwide reassessment of governance. As nations across the globe transform their health care systems, they are simultaneously redefining the responsibilities of the state, the private sector, and the individual in the process.

This panel takes a comparative approach to the analysis of transformations in health insurance plans worldwide. We begin with a theoretical discussion of what anthropologists can contribute to the study of health insurance and the way such analysis can illuminate transformations in governance and in ideas of “the social.” Then, taking up the PPACA as the panel’s foundation, we examine what it may mean for different sub-groups—such as Native Americans, the chronically ill, and undocumented immigrants –and for a variety of types of health care (such as mental health and complementary and alternative medicine). What does health care reform mean in practice to a variety of stakeholders—including patients and providers—and how expansive a definition of “health care” does it embrace? Finally, we place the PPACA in global context. We conclude with case studies of similar restructurings of governance in other nations—such as cash transfer programs in Mexico, Ecuador and Peru, and the transformation of universal insurance in Vietnam.

Abstract

Although anthropologists and many genetic scientists have long argued against the biological basis for distinguishing populations into racial categories, race remains an important concept in clinical medicine. Despite substantial evidence to support the contrary, medical researchers continue to seek genetic explanations for observed racial differences in disease incidence and prevalence. As a result, beliefs regarding the genetic basis for racial differences in health are being translated into medical practice and medical professionals routinely draw on racial stereotypes in making decisions regarding diagnosis and treatment. Outside of the clinic, these stereotypes regarding health disparities are infiltrating the public arena and becoming synonymous with minority communities. Drawing on ethnographic research conducted in primary care clinics, this paper examines how a group of primary care clinicians (n= 58) understand the role of race and ethnicity in health disparities. I start off with briefly examining the social justice background of health disparities in the United States and its transformations over the years. I then move to the clinicians to explore the socioeconomic, cultural, genetic dimensions of their responses highlighting how the decontextualization of discrimination based reasoning for the existence of health disparities facilitates the implementation of race based care with clinicians.

My project will be split up into two components: building a data repository using Kora and writing a corresponding white paper that will discuss my experiences in constructing a model for qualitative data. The first component, the data repository, will house qualitative data, such as one-on-one/focus groups interview transcripts and participant observation field notes.  From my experience, it is this type of data that produces much anxiety for qualitatively driven anthropologists. The repository will also host multimedia content such as photos, audio and video. Another important aspect of the repository will be the inclusion of supplementary material, such as project bios, interview guides, consent forms and code books. Despite the wide range of content proposed for the digital repository, a primary concern that cuts across all platforms for anthropologists, who conduct research with human subjects, is confidentiality and human subject protection. This project seeks to address these issues through the construction of a model that will attempt to embody these concerns.

For the second component of my project, I will be working on a white paper that will compliment my experience constructing a data repository for qualitative data. Using my experience as an example, my intention is to use this space to discuss concerns around confidentiality and intellectual property and how they can be addressed or at least mitigated by a set of best practices that will be generated based on my model. One of the most important variables to be considered will be issues of privacy and confidentiality: How can we identifiers will be need to be removed without significantly changing the presented material? As a medical anthropologist, how do I deal with the collection of sensitive medical information and how much of this should be included?

Image used by ThisParticularGreg

The second phase of this project will involve constructing a teaching corner for the publication with other interns. The teaching corner will feature classroom discussion questions, educational links as well as lesson plans.