Papers

This paper explores how recent legislative and technological changes in the US and the UK are devising new systems and practices of risk within private and social health insurance. Healthcare systems globally are confronted by three major challenges: costs outpacing growth in GDP; uneven quality in outcomes and patient experience; and inadequate access to care (WHO 2014; Halvorson et al. 2012). Digital transformations hold out the promise of addressing these challenges through initiatives ranging from digitized health records to remote consultations to self-care managed through apps and wearable devices. Insurance systems nationally, whether nominally public or private, are central to how such digital initiatives are being orchestrated to meet these challenges and to incentivize improved care and healthy behaviour. Globally, insurance is the key infrastructure underpinning healthcare financing. While private, multi-payer systems such as that in the US are sometimes described as an insurance model; single-payer, welfare-based systems like the NHS also employ risk-spreading, insurance-like techniques and retain a contributory element through national insurance. The public /private distinction is significant but it obfuscates the fact that both healthcare systems feature a hybrid mixture of public subsidy and private finance. Recent reforms further this hybridity by increasing the scope for competition and private provision in the UK while extending public subsidy in the US. This context of legislative and technological disruption, in combination with changes to international trade regulations like TTiP, the global circulation of healthcare finance reform experts between government and industry, and the emergence of new providers from outside of the insurance sector, is already beginning to alter how risks are devised in health insurance and funding.