The effects of mandatory health insurance on equity in access to outpatient care in Indonesia.
This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.
Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany. Budi.Hidayat@urz.uni-heidelberg.de
Budi
B
Hidayat
Hasbullah
H
Thabrany
Hengjin
H
Dong
Rainer
R
Sauerborn
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007214:Indonesia; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D007407:Interviews as Topic; D037141:Mandatory Programs / Q000191:economics*; D017059:Models, Econometric; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D017149:Private Sector; D017150:Public Sector; D012959:Socioeconomic Factors