HAS REFORM OF THE SYSTEM OF PUBLIC HEALTH INSURANCE FOR THE POOR IN INDONESIA INCREASED HEALTH INEQUALITY? CONSIDERING DIFFERENT ACCESSIBILITY OF PUSKESMAS
DOI:
https://doi.org/10.31092/jia.v3i2.584Keywords:
public health insurance reform, public health insurance claim, health inequality, healthcare accessibilityAbstract
Though the Indonesian government reformed its public health insurance system for the poor in 2008, the country still faces challenges with the disparity of accessibility to primary healthcare centres (puskesmas). This study examines whether the 2008 healthcare system reforms increased health inequality of the poor. Using data from the RAND Indonesian Family Life Survey (IFLS) and The Village Potential Statistics (PODES), this study found an indication that, in the aftermath of the reforms, the gap widened in the tendency for the poor to make insurance claims depending on their level of access to healthcare centres. Therefore, to protect the poor from catastrophic out-of-pocket expenditure, besides the provision of public health insurance, the government needs to be concerned about the accessibility of public health care, which includes not only the provision of direct healthcare infrastructure, but also improving road access conditions.References
Aji, B, Allegri, M, D, Souares, A, Sauerborn, R, (2013), ‘The impact of health insurance programs on out-of-pocket expenditures in Indonesia: An increase or a decrease?’, Int. J. Environ. Res. Public Health, 10, 2995-3013
Agustina, R, Dartanto, T, Sitompul, R, Susiloretni, K, A, Suparmi, Achadi, E, L, Taher, A, Wirawan, F, Sungkar, S, Sudarmono, P, Shankar, A, H, Thabrany, H, (2018), ‘Universal health coverage in Indonesia: concept, progress, and challenges’, Lancet, 393,75-102
Ahmed S, Creanga AA, Gillespie DG, Tsui AO (2010) Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries. PLoS ONE 5(6): e11190
Aspinal, Edward, (2014), ‘Health care and democratization in Indonesia’, Democratization, 21:5, 803-823
Bredenkamp, C, Evans, T, Lagrada, L, Langenbrunner, J, Nachuk, S, Palu, T, (2015), ‘Emerging challenges in implementing universal health coverage in Asia’, Social Science & Medicine, 145, 243-248
De, Dipawinta, (2014), “Spatial Inequality in Health Care Infrastructure in Sundarban, West Bengal, India’ , International Research Journal of Social Sciences, 3(12), 15–22.
Dodd, W, King, N, Humphries, S, Little, M, Dewey, C, (2016), ‘Self-reported morbidity and health service utilization in rural Tamil Nadu, Indiaâ€, Science & Medicine, 63, 691-705
Freeman, H, E, Corey, C, R, (1993), ‘Insurance Status and Access to Health Services among Poor Persons’, Health Services Research, 28, 5
Grignon, M, Perronnin, M, Lavis, J, N, (2008), ‘Does free complementary health insurance help the poor to access health care? Evidence from France’, Health Economics,17, 203-219
Harimurti, P, Pambudi, E, Pigazzini, A, Tandon, A, (2013), ‘The Nuts & Bolts of Jamkesmas, Indonesia’s Government-Financed Health Coverage Program’, Universal Health Coverage Studies Series (UNICO), No.8
Hidayat, B, Thabrany, H, Dong, H, Sauerborn, R, (2004), ‘The effect of mandatory health insurance on equity in access to outpatient care in Indonesia, Health Policy and Planning, 19, 322-335
Mahendradhata, Y, Trisnantoro, L, Listyadewi S, Soewondo, P, Marthias, T, Harimurti, P, Prawira, J, (2017), ‘The Republic of Indonesia Health System Review’, Health System in Transition, Vol. 7 No.1. WHO Regional Office for South-East Asia.
Manjia, M, B, Kouamou, G, E, Pettang, C, (2018) The geographical accessibility as a key access parameter to health care in Cameroon: modelling, measurement and evaluation, Journal of Decision Systems, 27:sup1, 155-163
Ministry of Health, (2007), Indonesian Health Profile 2007, Jakarta
Ministry of Health, (2009), Indonesian Health Profile 2009, Jakarta
Ministry of Health, (2009), Riset Kesehatan Dasar (Riskesdas) 2013, Jakarta
Ministry of Health, (2014) Indonesian Health Profile 2014, Jakarta
Pisani, E, Kok, M, O, Nugroho, K, (2017), ‘Indonesia’s road to universal health coverage: a political journey’, Health Policy and Planning, 32, 267-276
Rolindrawan, D, (2015), The Impact of BPJS Health Implementation for the Poor and Near Poor on the Use of Health Facilit, Procedia - Social and Behavioral Sciences, 211(September), 550–559
Sparrow, R, Suryahadi, A, Widyanti, W, (2013), ‘Social health insurance for the poor: Targeting and impact of Indonesia’s Askeskin programme’, Social Science & Medicine, 96, 264-271
Sparrow, R, Budiyati, S, Yumna, A, Warda, N, Suryahadi, A, Bedi, A, S, (2017), ‘Sub-national health care financing reforms in Indonesia’, Health Policy and Planning, 32, 90-101
Statistics Indonesia, (2014), Podes Guidelines 2014, Jakarta
Strasser, R, Kam, S, M, Regalado, S, M, (2016), ‘Rural health care access and policy in developing countries’, Annual Review of Public Health, 37, 395-412
Tanser, F, Gijsbertsen, B, Herbst, K, (2006), ‘Modelling and understanding primary health care accessibility and utilization in rural South Africa: An exploration using a geographical information system’, Social Science & Medicine, 63, 691-705
Wooldridge, Jeffrey M, (2016), ‘Introductory Econometrics: A modern approach’, Sixth Edition, Cengage Learning, Boston
World Health Organization, (2018), ‘Social determinants approaches to public health: from concept to practice’
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