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

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 s...

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Autores principales: Pratiwi, Agnes Bhakti, Setiyaningsih, Hermawati, Kok, Maarten Olivier, Hoekstra, Trynke, Mukti, Ali Ghufron, Pisani, Elizabeth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491299/
https://www.ncbi.nlm.nih.gov/pubmed/34607864
http://dx.doi.org/10.1136/bmjopen-2021-050565
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author Pratiwi, Agnes Bhakti
Setiyaningsih, Hermawati
Kok, Maarten Olivier
Hoekstra, Trynke
Mukti, Ali Ghufron
Pisani, Elizabeth
author_facet Pratiwi, Agnes Bhakti
Setiyaningsih, Hermawati
Kok, Maarten Olivier
Hoekstra, Trynke
Mukti, Ali Ghufron
Pisani, Elizabeth
author_sort Pratiwi, Agnes Bhakti
collection PubMed
description 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.
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spelling pubmed-84912992021-10-14 Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability Pratiwi, Agnes Bhakti Setiyaningsih, Hermawati Kok, Maarten Olivier Hoekstra, Trynke Mukti, Ali Ghufron Pisani, Elizabeth BMJ Open Health Policy 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. BMJ Publishing Group 2021-10-03 /pmc/articles/PMC8491299/ /pubmed/34607864 http://dx.doi.org/10.1136/bmjopen-2021-050565 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Health Policy
Pratiwi, Agnes Bhakti
Setiyaningsih, Hermawati
Kok, Maarten Olivier
Hoekstra, Trynke
Mukti, Ali Ghufron
Pisani, Elizabeth
Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability
title Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability
title_full Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability
title_fullStr Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability
title_full_unstemmed Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability
title_short Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability
title_sort is indonesia achieving universal health coverage? secondary analysis of national data on insurance coverage, health spending and service availability
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491299/
https://www.ncbi.nlm.nih.gov/pubmed/34607864
http://dx.doi.org/10.1136/bmjopen-2021-050565
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