Contested Security, Fragile Solidarities: The Domestication of Private Health Insurance for Children in Finland

This paper studies a financial instrument that is much used in contemporary Finland, but that by most of its users is not primarily thought about in terms of being a financial instrument: the private health insurance for children. The question examined in the paper is: how do economic, political and moral valuations become intertwined in the domestication of insurance? Examining this issue will shed light on the everyday pragmatics of valuing, evident in households with small children. The data studied are interviews with families with and without private health insurance policies for their children. In Finland, all children are covered by social insurance and are entitled to public health service with very low costs, if any. Yet, many families want to supplement this service: some 40% of children under 7 years are insured privately, despite the extra cost of some 350€ per year per child. In addition to an increased sense of security, families are willing to pay for the convenience of use; private health centres are seen as more flexible service providers for parents with demanding work schedules, and their level of service is often seen to be superior to that provided by the public health services. Many fear, however, that the strengthening of the private health care sector threatens to weaken further both the legitimacy of, and the service given by, the public sector. Simultaneously, inequality in the face of health risks is aggravated. Therefore, the widely spread use of this financial instrument has become politically controversial and morally laden. Parents can feel guilty if they do not take out a private policy for their children, that is, if they fail to do everything in their might to secure their loved ones’ well-being. However, they can also experience guilt for the absolutely contrary reason, for having taking out the policy; in this case they can feel that their decision has helped to undermine the social welfare that they otherwise would strongly support. It is also noteworthy that notwithstanding the relatively high cost of the private insurance policy, only very rarely are the primary modes of justifying its usage related to economic calculations or risk assessments, whereas the reasons for not taking out a policy for children can be directly linked to the disadvantaged economic situation of a household. The case studied in this paper makes it evident how a financial instrument such as health insurance can be assembled in ways that have fundamentally different societal effects. In general, insurance is an economic technology that creates security through elaborate actuarial calculations, the pooling of resources and the spreading of risk. Because insurance always involves the sharing of responsibility, solidarity is inherent to it. However, the Finnish case of health care insurance for children shows that insurance solidarities can go in many directions, and they can even be mutually exclusive. The analysis of this issue underscores that the way in which the insurance tool is assembled affects whether insurance creates solidarity with the population at large, as in the case of social insurance, or rather, only within the risk pool assembled by a private insurance company, or with the workplace, for example. What is solidarity for some can entail exclusion and inequality for others.