The impact of health insurance programs on out-of-pocket expenditures in Indonesia: an increase or a decrease?

Int J Environ Res Public Health. 2013 Jul 18;10(7):2995-3013. doi: 10.3390/ijerph10072995.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Data Collection
  • Family Characteristics
  • Female
  • Health Expenditures*
  • Health Status
  • Humans
  • Indonesia
  • Infant
  • Infant, Newborn
  • Insurance, Health / economics*
  • Male
  • Middle Aged
  • Models, Theoretical
  • Young Adult