Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability

Pratiwi, Agnes Bhakti and Setiyaningsih, Hermawati and Kok, Maarten Olivier and Hoekstra, Trynke and Mukti, Ali Ghufron and Pisani, Elizabeth (2021) Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability. BMJ Open, 11 (10). ISSN 20446055

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Abstract

Objectives To analyse the relationship between health need, insurance coverage, health service availability, service use, insurance claims and out-of-pocket spending on health across Indonesia. Design Secondary analysis of nationally representative quantitative data. We merged four national data sets: the National Socioeconomic Survey 2018, National Census of Villages 2018, Population Health Development Index 2018 and National Insurance Records to end 2017. Descriptive analysis and linear regression were performed. Setting Indonesia has one of the world's largest single-payer national health insurance schemes. Data are individual and district level; all are representative for each of the country's 514 districts. Participants Anonymised secondary data from 1 131 825 individual records in the National Socioeconomic Survey and 83 931 village records in the village census. Aggregate data for 220 million insured citizens. Primary outcome measures Health service use and out-of-pocket payments, by health need, insurance status and service availability. Secondary outcome: insurance claims. Results Self-reported national health insurance registration (60.6) is about 10 lower compared with the insurer's report (71.1). Insurance coverage is highest in poorer areas, where service provision, and thus service use and health spending, are lowest. Inpatient use is higher among the insured than the uninsured (OR 2.35, 95 CI 2.27 to 2.42), controlling for health need and access), and poorer patients are most likely to report free inpatient care (53 in wealth quintile 1 vs 41 in Q5). Insured patients spend US 3.14 more on hospitalisation than the uninsured (95 CI 1.98 to 4.31), but the difference disappears when controlled for wealth. Lack of services is a major constraint on service use, insurance claims and out-of-pocket spending. Conclusions The Indonesian public insurance system protects many inpatients, especially the poorest, from excessive spending. However, others, especially in Eastern Indonesia cannot benefit because few services are available. To achieve health equity, the Indonesian government needs to address supply side constraints and reduce structural underfunding. © 2021 BMJ Publishing Group. All rights reserved.

Item Type: Article
Additional Information: Cited by: 17; All Open Access, Gold Open Access, Green Open Access
Uncontrolled Keywords: Health Expenditures; Humans; Indonesia; Insurance Coverage; Medically Uninsured; Universal Health Insurance; adult; article; government; health care policy; health care utilization; health equity; hospital patient; human; Indonesia; linear regression analysis; medically uninsured; national health insurance; outcome assessment; secondary analysis; health care cost; Indonesia; insurance
Subjects: R Medicine > RP Public Health and Nutrition
Divisions: Faculty of Medicine, Public Health and Nursing > Biomedical Sciences
Depositing User: Sri JUNANDI
Date Deposited: 28 Sep 2024 06:10
Last Modified: 28 Sep 2024 06:10
URI: https://ir.lib.ugm.ac.id/id/eprint/4464

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