title: The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach.
abstract: BACKGROUND
  Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs.
  
  
  METHODS
  Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data.
  
  
  RESULTS
  Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses.
  
  
  CONCLUSIONS
  Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from extended family members, donations from neighbors and the community, and additional benefits from employers. However, insured households overall had positive perceptions of insurance.
authors.affiliation: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Germany; School of Public Health, Faculty of Medicine and Health Sciences, Jenderal Soedirman University, Purwokerto, Indonesia; budi.aji57@gmail.com.
authors.forename: Budi
authors.initials: B
authors.lastname: Aji
authors.affiliation: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Germany.
authors.forename: Shelby Suzanne
authors.initials: SS
authors.lastname: Yamamoto
authors.affiliation: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000208:Acute Disease / Q000191:economics*; D002908:Chronic Disease / Q000191:economics*; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007214:Indonesia; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D062407:Meals; D036301:Qualitative Research; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014186:Transportation / Q000191:economics
keywords: Indonesia; economic impact; qualitative study; severe illnesses