Making markets for development. The consequences of India's new health insurance for experiences of illness and healings among urban and rural poor in India

该项目调查了一项针对印度穷人的新医疗保险的社会和文化后果（RSBY, Rashtriya Swasthya Bima Yojana，字面意思是：国家健康保险方案）。该倡议于2009年启动，旨在保护生活在贫困线以下的人在重大卫生危机期间免于财务破产。最低费用为30卢比（0.42欧元），符合条件的参与者可获得私人健康保险（由政府支付），其中包括住院治疗，每年最高可达30,000卢比（420欧元）。该保险还使穷人享有在私人诊所接受高质量治疗的特权，使他们不必在人满为患的政府医院排长队。然而，新的好处是有代价的。参与者需要做出令人生畏的决定，以最佳方式利用有限的资源，这些资源很少能覆盖所有家庭成员，在困难的情况下，也不会支付整个治疗费用，就像癌症的情况一样。对项目的结构、程序和政策进行了大量的讨论。然而，到目前为止，其社会和文化影响在很大程度上仍未得到探索。作为一项人类学项目，本研究优先考虑受益者的观点。我们将调查从获得新保险开始的健康和治疗方法的变化。RSBY如何改变当地对疾病和身体概念的解释？关于最佳使用的谈判如何影响性别关系，它们如何与其他财务决策纠缠在一起？比较边缘农村地区（恰蒂斯加尔邦、奥里萨邦）和德里城市中心的经验，将有助于深入分析一系列社会影响。它将丰富关于疾病的文化重新谈判的学术辩论，并促进关于新形式的发展主义的批判性讨论。今天，RSBY是世界上最大的保险计划，并被誉为发展实践的里程碑。对实地社会实践的人类学调查也将有助于理解意想不到的后果、新的悖论和社会冲突。这对进一步推进医疗市场化改革具有重要意义。从概念上讲，该项目将引导讨论在不断扩大的市场中不断变化的团结和社会保障经验。医疗改革如何改变人们对国家机构和市场的看法和遭遇？公私伙伴关系如何影响公民观念？该项目将通过研究重大福利改革的拨款，推进关于市场霸权时代新主体地位的人类学辩论。

The project investigates the social and cultural consequences of a new health insurance for poor people in India (RSBY, Rashtriya Swasthya Bima Yojana, literally: National Health Insurance Programme). The initiative was launched in 2009 and aims to protect people living below the poverty line from financial ruin during major health crises. For a minimal fee of 30 Rupees (0,42 Euro) eligible participants receive a private health insurance (paid for by the government) that covers in-patient hospital treatment up to an annual maximum of 30.000 Rupees (420 Euro). The insurance gives also poor people privileged access to high quality treatment in private clinics allowing them to avoid long queues in overcrowded government hospitals. Yet, the new benefit comes at a cost. Participants partake in daunting decisions about best usage of a limited resource that can rarely cover all family members and in difficult cases does not pay for the entire treatment, as it is the case with cancer. There is substantial discussion about the structure of the project, its procedures and policies. Yet, so far the social and cultural impact remains largely unexplored.As an anthropological project this study privileges the perspectives of beneficiaries. We will investigate changing approaches to health and healing that follow on from access to the new insurance. How does RSBY change local interpretations of illness and notions of the body? How do negotiations about best usage impact gender relations and how are they entangled with other financial decisions? The comparison of experiences in marginalized rural areas (Chhattisgarh, Orissa) and the urban center of Delhi will facilitate an in-depth analysis of a range of social effects. It will enrich academic debates about cultural re-negotiations of illness and promote critical discussions about novel forms of developmentalism.Today RSBY is the largest insurance scheme worldwide and is celebrated as a milestone in development practice. The anthropological investigation of on-the-ground social practices will facilitate an understanding also of the unexpected consequences, new paradoxes and social conflicts. This is crucial information for further advancement in health market reform. Conceptually, the project will lead discussions about changing experiences of solidarity and social security in expanding markets. How does the health reform change people's perception of and encounters with state institutions and the market? And how does the private public partnership impact on notions of citizenship? The project will advance anthropological debates about new subject positions in an era of market hegemony by studying the appropriation of a significant welfare reform.