Evaluating equity in health systems financing in Indonesia

印度尼西亚已经开始实施一项雄心勃勃的计划，到2019年实现全民健康覆盖（UHC），其国家健康保险计划处于前列。虽然印度尼西亚取得了稳步进展，但仍有约三分之一的人口没有医疗保险，即使在投保人中，自付医疗费用也很普遍。在未来两年中，政府将加大力度，利用需求和供应方举措的复杂组合来扩大国家计划。随着人们越来越担心穷人可能会在追求全民健康覆盖的过程中被抛在后面，我的研究将提供急需的证据，证明改革的公平影响和印度尼西亚在普及主义方面的整体进展。我的研究将涉及三个广泛的目标。首先，使用效益发生率分析（BIA）的技术，我将衡量不同的社会经济群体通过使用卫生服务从公共卫生融资中受益的程度。在这样做的时候，我还将推进传统的方法，通过加权卫生支出的好处，以反映服务的质量，特别是在印度尼西亚这样的国家，穷人通常使用较低质量的卫生服务相比，丰富的重要。其次，我将使用计量经济学技术来衡量保险所有权对一系列行为结果的影响，包括服务利用率、自付支出以及贫困和灾难性的医疗支出。第三，我将进行定性研究，以了解在印度尼西亚实施UHC改革的背景和过程。我的研究目标将使用两个大型横断面家庭调查（增强调查），国家卫生设施数据集，并在UHC改革的主要利益相关者进行深入访谈。这项研究对于了解印度尼西亚医疗保险政策的真正影响，特别是对穷人的影响至关重要。

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.