title: The impact of health insurance programs on out-of-pocket expenditures in Indonesia: an increase or a decrease?
abstract: We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.
authors.affiliation: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany. Aji@stud.uni-heidelberg.de
authors.forename: Budi
authors.initials: B
authors.lastname: Aji
authors.forename: Manuela
authors.initials: M
authors.lastname: De Allegri
authors.forename: Aurelia
authors.initials: A
authors.lastname: Souares
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures; D006304:Health Status; D006801:Humans; D007214:Indonesia; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D055815:Young Adult