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Indonesia's health development geared to achieve national health insurance scheme (JKN).However, funding of health in Indonesia is still dominated by domestic funding through out-of-pocket (OOP). Catastrophic health expenditure of households will disrupt householdconsumption and can lead to poverty. By using secondary data of the National Social Surveys(Susenas) 2012, this study aims to prove health insurance ownership lowers catastrophic healthexpenditure of households in Indonesia in 2012. This study used a cross-sectional study designwith models probit and bivariate probit. The results found that the health insurance ownershiplowers catastrophic health expenditure in the amount 12.97% at the threshold 10% of totalexpenditure and 18.42% at 20% of total non-food expenditure. Health insurance ownershipprovides protection for catastrophic health expenditure in Indonesia in 2012.Keywords: Health insurance, Catastrophic health expenditure, Probit, Bivariate probit, Susenas.
Institutional delivery has an impact on decreasing maternal mortality. InIndonesia, institutional delivery increases every year, but there are still 30%-37%delivery at home. Unfortunately, the increase did not in line with maternalmortality reduction so that Indonesia did not achieve the fifth MDGs goal. Inorder to achieve Universal Health Coverage, Indonesia implemented JaminanKesehatan Nasional (JKN) for all. JKN integrated four types of health insurance.One of its benefits is maternal health services. Health insurance can addressfinancial barriers on delivery in health facility.Using secondary data of Riskesdas 2013 and Podes 2011, the study aims toinvestigate the effect of health insurance on institutional delivery in Indonesia.The estimation of the effect used probit and bivariate probit models to take intoaccount the issue of endogeneity of health insurance.The result found that health insurance tends to increase institutional delivery by39.52%. Furthermore, the increase is expected to reduce maternal mortality.Keywords: Health insurance, Institutional delivery, Probit, Bivariate probit.
Seven years since the national health insurance scheme (JKN) was introduced, coverage in DKI Jakarta Province has reached 85% of the population, but the average out-of-pocket (OOP) health expenditure of DKI Jakarta residents is twice that of the national expenditure. The high JKN coverage was accompanied by an increase in OOP in DKI Jakarta Province. This study focuses on understanding how health insurance ownership relates to health service utilization and cash health expenditure in DKI Jakarta Province. This study uses secondary data from Susenas Kor in 2021. The quantitative analysis conducted in this study includes two stages, the first stage using individual-level data to determine the determinants of individual health behavior on health service utilization. The second stage was carried out using household-level data to determine the tendency of health insurance utilization with out-of-pocket health expenditure in DKI Jakarta Province. This study found that the economic status of the population in quintile one (Q1) and quintile two (Q2) is the largest group of people who do not have health insurance. The results of the first stage of analysis show that DKI Jakarta residents prefer privately-run health facilities for outpatient utilization, while government-operated health facilities are slightly superior for inpatient utilization. Residents who have JKN will use it for outpatient and inpatient utilization. The results of the second stage showed that the out-of-pocket cash health expenditure of people with national health insurance (JKN) was lower than that of people without health insurance. Residents who have dual/combination health insurance (JKN and private) when utilizing health services are using private health insurance. The higher the economic status of the population, the higher their health expenditure. This study suggests that the government should pay close attention to the coverage of health insurance among people with low economic status. It also needs to encourage people to make more use of JKN when utilizing outpatient and inpatient care in order to further reduce financial risk, especially for people with vulnerable household members.
In addition to morbidity and mortality are high, financing catastrophic diseases(kidney failure, cardiovascular disease, cancer, thalassemia and hemophilia) thatabsorb very high cost should be a serious concern. The study aims to analyze thecost of catastrophic diseases based on the characteristics of participants.Quantitative research analytical uses claims data in the form of data BPJSparticipants and costs in 2014 amounted to 309 301 claims. The analysis showedsignificant difference in the average cost of catastrophic illness according tolength of stay, classes and class hospital care. Promotive, preventive and diseasemanagement of patients need to be improved to achieve cost effectiveness andefficiency of health care in ensuring the sustainability of national health insuranceprogram.Key words:Catastrophic diseases, hospital expenses, characteristic of participant, promotive,preventive and disease management.
Out-of-pocket (OOP) healthcare in National Health Insurance (NHI) participationindicates that NHI was not yet optimal to provide financial protection. Furthermore, It‟simportant for low-middle-income countries to look at catastrophic incidence inhousehold. The aim of this study was to examine the relationship between NHIownership on household with OOP healthcare and catastrophic incidence, and alsodescribe the impoverishment because of OOP healthcare in household from 2014 to2016. This study use Susenas data 2014 to 2016 and analyzed by econometric approach.For OOP healthcare in household estimated by Ordinary Least Square (OLS), forcatastrophic incidence in household estimated using logit model, and to describeimpoverishment in household analyzed by looking at household expenditure before andafter taking into acoount OOP healthcare. The proportion of JKN ownership inhousehold from 2014 to 2016 can provide financial protection in the form of decreasedOOP healthcare and prevent catastrophic incidence in household, and become indirecteffect reducing impoverishment in household. In the future, we need to focus expandingNHI participation and increasing promotive and preventive programme in order toachieve Universal Health Coverage.Keywords: Out-of-Pocket, Catastrophic Incidence, Impoverishment, National HealthInsurance, Universal Health Coverage.
Penelitian ini bertujuan mengetahui peran jaminan kesehatan dan determinan yang mempengaruhi pemanfaatan pelayanan kesehatan oleh penyandang disabilitas di Indonesia pada tahun 2021 menggunakan data Susenas Maret 2021. Variabel terikat penelitian ini adalah pemanfaatan pelayanan kesehatan rawat jalan dan rawat inap di FKTP dan FKRTL. Data dianalisis secara bivariat dan multivariat dengan metode Binary Regression menggunakan model logit. Diketahui variabel kepemilikan jaminan kesehatan, pemanfaatan JKN, jenis disabilitas, tingkat keparahan disabilitas, jenis kelamin, pendidikan, status pekerjaan, status kawin, jumlah anggota rumah tangga, dan karakteristik tempat tinggal serta status ekonomi berpengaruh signifikan pada pemanfaatan layanan rawat jalan dan rawat inap (p-value 0,000 <0,005). Kepemilikan jaminan kesehatan non JKN atau kepemilikan jaminan kesehatan ganda (JKN dan non JKN) meningkatkan peluang pemanfaatan layanan baik rawat inap maupun rawat jalan. Terjadi penurunan kepemilikan jaminan kesehatan terhadap peningkatan status ekonomi penyandang disabilitas (propoor). Sebaliknya terjadi tren peningkatan pemanfaatan jaminan kesehatan terhadap peningkatan status ekonomi keluarga penyandang disabilitas (prorich).
This research aims to determine the role of health insurance and the determinants that influence the use of health services by people with disabilities in Indonesia in 2021 using Susenas data for March 2021. The dependent variable of this research is the use of outpatient and inpatient health services at FKTP and FKRTL. Data were analyzed bivariately and multivariately using the Binary Regression method using the logit model. It is known that the variables of ownership of health insurance, utilization of JKN, type of disability, severity of disability, gender, education, employment status, marital status, number of household members, and characteristics of residence and economic status have a significant effect on the utilization of outpatient and inpatient services ( p-value 0.000 <0.005). Ownership of non-JKN health insurance or ownership of dual health insurance (JKN and non-JKN) increases the chances of utilizing both inpatient and outpatient services. There has been a decrease in ownership of health insurance due to an increase in the economic status of people with disabilities (propoor). On the contrary, there is a trend of increasing use of health insurance towards increasing the economic status of families of people with disabilities (prorich).
Indonesia telah menjadi pelopor dalam pengelolaan program jaminan kesehatan sosial (JKN) terbesar di dunia. Program ini diinisiasi sejak tahun 2011 berdasarkan Undang-Undang No 40 tahun 2004 tentang Sistem Jaminan Sosial Nasional dengan pencapaian kepesertaan JKN sebesar 96% terhadap jumlah penduduk pada Desember 2023. Cakupan kesehatan semesta sebagai salah satu upaya dalam program JKN tidak hanya berkaitan dengan kepesertaan, tetapi juga mencakup manfaat yang diterima serta mekanisme pembiayaannya. Ekuitas sebagai salah satu asas dalam memenuhi persyaratan Universal Health Coverage (UHC) masih menjadi masalah dalam pelaksanaan program JKN ini, hal ini terlihat dari data grafik yang dianalisa oleh Ascobat Gani pada tahun 2019 bahwa masih terjadi disparitas yang sangat signifikan antara wilayah propinsi di Indonesia. Tujuan dari penelitian ini untuk melakukan analisis terhadap faktor dari sisi penyedia atau supply side yang mempengaruhi terjadinya disparitas pemanfaatan layanan kesehatan pada fasilitas kesehatan tingkat pertama program JKN. Penelitian ini menggunakan data sekunder BPJS Kesehatan, dan data publikasi dari Kementrian Keuangan dan Kemntrian Dalam Negeri serta Badan Pusat Statistik. Data dianalisis secara univariat, bivariat, dan multivariat dengan menggunakan metode regresi linier berganda. Secara statistik, pemanfaatan layanan kesehatan ditingkat pertama dipengaruhi sebesar 30% oleh kondisi geografis melalui alat ukur status keterpencilan Desa melalui variabel Skor Indeks Desa Membangun (IDM), dan kondisi sosioekonomi melalui alat ukur kapasitas fiskal dan persentase Pendapatan Asli Daerah (PAD) terhadap APBD kabupaten dan kota. Skor IDM dan Persentase PAD terhadap APBD secara signifikan berpengaruh positif sedangkan rasio kapasitas fiskal daerah secara signifikan berpengaruh negatif dengan nilai signifikansi P < 0,05 terhadap kontak rate kunjungan rawat jalan tingkat pertama
Indonesia has become a pioneer in managing the largest social health insurance (JKN) program in the world. This program was initiated in 2011 based on Law No. 40 of 2004 concerning the National Social Security System with the achievement of JKN membership of 96% of the total population in December 2023. Universal health coverage as one of the efforts in the JKN program is not only related to membership, but also includes the benefits received and the financing mechanism. Equity as one of the principles in fulfilling Universal Health Coverage (UHC) requirements is still a problem in the implementation of the JKN program. This can be seen from graphic data analyzed by Ascobat Gani in 2019 that there are still very significant disparities between provincial regions in Indonesia. The aim of this research is to conduct an analysis of factors from the provider side or supply side that influence disparities in health service utilization in first level health facilities of the JKN program. This research uses secondary data from BPJS Kesehatan, and published data from the Ministry of Finance and Ministry of Home Affairs as well as the Central Statistics Agency. Data were analyzed univariately, bivariately and multivariately using multiple linear regression methods. Statistically, the utilization of health services at the first level is influenced by 30% by geographical conditions through measuring village remoteness status through the Village Development Index Score (IDM) variable, and socio-economic conditions through measuring fiscal capacity and the percentage of Regional Original Income (PAD) to the district APBD and city. The IDM score and the percentage of PAD to APBD have a significant positive effect, while the regional fiscal capacity ratio has a significant negative effect with a significance value of P < 0.05 on the contact rate of first level outpatient visits.