Objectives
This study evaluates the impact of an expanded national health insurance programme in Indonesia, focusing on three outcomes: access to health care, as measured by utilisation of health care services; financial protection, as measured by out-of-pocket (OOP) health expenditure and catastrophic health expenditure (CHE) indicators; and health status, as measured by levels of blood pressure and rates of diagnosed, treated and controlled hypertension.
Research Methods
This study uses longitudinal data from the Indonesian Family Life Survey (IFLS) collected from 13 Indonesia’s provinces, a total of 22,711 adults in 2007 who were followed up in 2014. The JKN enrolees are categorised into two groups: a contributory group who paid the premium voluntarily, and a subsidised group, paid by government. Each group is compared with the uninsured group who had no insurance coverage in both 2007 and 2014. Propensity score matching combined with difference-in-difference approaches are used to estimate the causal effect of the JKN programme. Heterogeneity of the effects of JKN is explored based on socioeconomic status, locality of residence (urban/rural), and availability of health facilities in the area.
Results
The JKN programme increased the probability of individuals in the contributory group seeking outpatient and inpatient care as well as the volume of care provided. The subsidised group also showed increased utilisation, but the magnitude of the effect is much smaller than in the contributory group. In relation to financial protection, the JKN programme had no statistically significant effect on OOP health expenditure or catastrophic health expenditure. In terms of health outcomes, while the programme had no significant effect on systolic or diastolic blood pressure, the data suggest a positive effect on increasing awareness and treatment of hypertension among the contributory group and, to a lesser extent, the subsidised group.
Conclusions
The JKN programme encouraged individuals in the contributory group to use more medical treatment, which had no effect, on average, on their health expenditure. The subsidised group appears not to have been able to maximise the JKN benefit, possibly due to other barriers in access to care, such as the inadequate supply of health facilities. The impact of the JKN programme on health status is yet to be confirmed as sufficient time has not passed for the programme’s effect on health status to be realised
