Evaluating equity in health systems financing in Indonesia

点击翻译按钮获取中文摘要

Indonesia has embarked on an ambitious program to achieve universal health coverage (UHC) by 2019 with its national health insurance scheme at the forefront. While Indonesia has made steady progress, around a third of its population remains without cover and out of pocket payments for health are widespread even among the insured. Over the next 2 years, the government will be increasing its efforts to scale up the national scheme using a complex mix of demand and supply side initiatives. Amid growing concerns that the poor may be left behind in the pursuit of UHC, my research will provide much needed evidence on the equity-impact of the reforms and Indonesia's overall progress to universalism. My research will address 3 broad objectives. First, using the technique of benefit incidence analysis (BIA), I will measure the extent to which different socioeconomic groups benefit from public financing for health through their use of health services. In doing so, I will also advance conventional methodology by weighting the benefits of health spending to reflect quality of services, especially important in countries such as Indonesia where the poor typically utilise lower quality health services compared to the rich. Second, I will use econometric techniques to measure the effect of insurance ownership on a range of behavioural outcomes including utilisation of services, out-of-pockets spending, and impoverishing and catastrophic health expenditure. Third, I will conduct qualitative research to understand the context and process of implementing UHC-reforms in Indonesia. My research objectives will be met using two large cross sectional household surveys (ENHANCE Surveys), national health facility data sets, and in-depth interviews with key stakeholders in UHC reforms. This research will be critically important to understanding the true impact of Indonesia's health insurance policies, especially on the poor.