The cost of caste?
The caste system in India is one of the world’s oldest forms of surviving social classification. Despite an official ban in 1948, discrimination based on caste is still prevalent today. However, Dr Roy and co-authors have discovered that financial incentives could help to overcome social barriers and entrenched caste prejudice when it comes to accessing healthcare.
Dr Roy and her team employed local women in the state of Karnataka in southwest India to visit families and create public awareness of the National Health Insurance Scheme amongst those for whom the program was intended.
One agent was employed per village and, while all agents were paid to do this job, some randomly selected agents were given the additional incentive of a small payment depending on how well the beneficiary households scored on a follow up knowledge test about the healthcare scheme. This meant that the researchers could identify whether financial initiatives for agents were effective in improving information flow.
The results showed that financially incentivised agents improved beneficiary knowledge of the scheme and achieved higher subsequent enrolment rates. In fact, interviews with beneficiaries found that compared to their non-incentivised counterparts, these agents spent less time on people of similar caste, education and poverty status, and more time with those different to themselves – ensuring these beneficiaries understood the scheme well and knew how to enrol.
Dr Roy explains: "It appears that this incentive payment pushed the agents to engage with people of all castes and encourage them to enrol in the healthcare scheme.
"If the agent wasn’t incentivised, but was from different caste than the beneficiary, enrolment rates were lower.
"This suggests that, without a financial incentive, people may simply prefer not to interact with people from different castes. This is the common ‘preference’ story that is cited in literature, but we now want to test this."