Disparities Among Different Type of Health Insurance Schemes and Uninsured in Indonesia: Challenges to Equity and Access to Health Care

Type Journal Article - Social Science ResearchNetwork
Title Disparities Among Different Type of Health Insurance Schemes and Uninsured in Indonesia: Challenges to Equity and Access to Health Care
Author(s)
Publication (Day/Month/Year) 2013
URL http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2211559
Abstract
Rationale: Currently 37% of population or about 88 million people in Indonesia does not have health insurance. For those who are not covered means access to health care is mainly from out of pocket. While the existing health insurance is still provided by various type of scheme, with different benefit package and amount of contribution.

Objectives: To review whether the various insurance status are associated with the access to out-patient and in-patient care.

Methods: Cross-sectional data from the 2011 National Social Economic Survey, conducted by the National Center for Statistics, were analyzed for the uninsured and insured population under different health insurance schemes using a correlational design (N=95.331.974).

Results: The focus is on comparisons of health care utilization among persons who are uninsured, received indigent health insurance scheme, other government scheme and private scheme. The study examines the National Social Economic Survey that has been collected for the year 2011. From the total sample, 56,79% is uninsured while the insured population has been covered under the various scheme. For the population with indigent scheme (Jamkesmas) is less likely to access out-patient care as to their counterpart uninsured (odds ratio=0,62), but almost twelve times as likely to access in-patient care (odds ratio=11,71). Insured persons covered by other government scheme for civil servant and employee are nearly one and a half times more likely in receiving out-patient care (odds ratio=1,38), and they are four times more frequent in accessing in-patient care (odds ratio=4,02). Whereas the persons with private scheme are more likely to access out-patient care for almost eleven times compare to the uninsured (odds ratio=10,55), and they are nearly two and a half times likely to go to the in-patient care (odds ratio=2,49).

Conclusions: Inequities in utilization of care by the uninsured particularly for accessing in-patient care is represented by these large disparities. This result provide an input for the government to accelerate the implementation of National Social Security System which has been enacted as law in 2004.

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