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Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia

The Indonesian government has made some ambitious steps to achieve Universal Health Coverage through the newly formed National Health Insurance [Jaminan Kesehatan Nasional (JKN)], establishing a single-payer insurance agency and prospective provider payment mechanism. This study aims to assess the b...

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Autores principales: Sambodo, Novat Pugo, Van Doorslaer, Eddy, Pradhan, Menno, Sparrow, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359753/
https://www.ncbi.nlm.nih.gov/pubmed/34077516
http://dx.doi.org/10.1093/heapol/czab015
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author Sambodo, Novat Pugo
Van Doorslaer, Eddy
Pradhan, Menno
Sparrow, Robert
author_facet Sambodo, Novat Pugo
Van Doorslaer, Eddy
Pradhan, Menno
Sparrow, Robert
author_sort Sambodo, Novat Pugo
collection PubMed
description The Indonesian government has made some ambitious steps to achieve Universal Health Coverage through the newly formed National Health Insurance [Jaminan Kesehatan Nasional (JKN)], establishing a single-payer insurance agency and prospective provider payment mechanism. This study aims to assess the benefit incidence of healthcare funding in the JKN era, and its distribution by socio-economic status considering regional variation in unit costs. We evaluate whether the benefit incidence of funding is skewed towards urban and wealthier households. We also investigate whether standard benefit incidence analysis using national unit costs underestimates regional disparities in healthcare funding. Lastly, we examine whether the design of the JKN provider payment system exacerbates regional inequalities in healthcare funding and treatment intensity. The analysis relies on Indonesia’s annual National Socio-economic Survey (Susenas) and administrative data on JKN provider payments from 2015 to 2017, combined at district level for 466 districts. We find that the benefit incidence of healthcare expenditure favours the wealthier groups. We also observe substantial variation in hospital unit costs across regions in Indonesia. As a result, standard benefit incidence analysis (using national average unit transfers) underestimates the inequality due to regional disparities in healthcare supply and intensity of treatment. The JKN provider payment seems to favour relatively wealthier regions that harbour more advanced healthcare services. Urban dwellers and people living in Java and Bali also enjoy greater healthcare benefit incidence compared to rural areas and the other islands.
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spelling pubmed-83597532021-08-13 Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia Sambodo, Novat Pugo Van Doorslaer, Eddy Pradhan, Menno Sparrow, Robert Health Policy Plan Original Article The Indonesian government has made some ambitious steps to achieve Universal Health Coverage through the newly formed National Health Insurance [Jaminan Kesehatan Nasional (JKN)], establishing a single-payer insurance agency and prospective provider payment mechanism. This study aims to assess the benefit incidence of healthcare funding in the JKN era, and its distribution by socio-economic status considering regional variation in unit costs. We evaluate whether the benefit incidence of funding is skewed towards urban and wealthier households. We also investigate whether standard benefit incidence analysis using national unit costs underestimates regional disparities in healthcare funding. Lastly, we examine whether the design of the JKN provider payment system exacerbates regional inequalities in healthcare funding and treatment intensity. The analysis relies on Indonesia’s annual National Socio-economic Survey (Susenas) and administrative data on JKN provider payments from 2015 to 2017, combined at district level for 466 districts. We find that the benefit incidence of healthcare expenditure favours the wealthier groups. We also observe substantial variation in hospital unit costs across regions in Indonesia. As a result, standard benefit incidence analysis (using national average unit transfers) underestimates the inequality due to regional disparities in healthcare supply and intensity of treatment. The JKN provider payment seems to favour relatively wealthier regions that harbour more advanced healthcare services. Urban dwellers and people living in Java and Bali also enjoy greater healthcare benefit incidence compared to rural areas and the other islands. Oxford University Press 2021-06-02 /pmc/articles/PMC8359753/ /pubmed/34077516 http://dx.doi.org/10.1093/heapol/czab015 Text en © The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Sambodo, Novat Pugo
Van Doorslaer, Eddy
Pradhan, Menno
Sparrow, Robert
Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia
title Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia
title_full Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia
title_fullStr Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia
title_full_unstemmed Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia
title_short Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia
title_sort does geographic spending variation exacerbate healthcare benefit inequality? a benefit incidence analysis for indonesia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359753/
https://www.ncbi.nlm.nih.gov/pubmed/34077516
http://dx.doi.org/10.1093/heapol/czab015
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