© Oxford University Press, 2004
The effects of mandatory health insurance on equity in access to outpatient care in Indonesia
1 Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany
2 School of Public Health, University of Indonesia, Indonesia
3 Center for Health Economic Studies, University of Indonesia, Indonesia
Correspondence: Budi Hidayat, Department of Tropical Hygiene and Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany. Tel: +49 6221 564886; fax: + 49 6221 565948; email: Budi.Hidayat{at}urz.uni-heidelberg.de
This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.
Key Words: access, equity, concentration index, health insurance, Indonesia, IFLS