Health Policy and Planning Advance Access published online on March 11, 2008
Health Policy and Planning, doi:10.1093/heapol/czn003
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Targeting the poor in times of crisis: the Indonesian health card
Institute of Social Studies, P.O. Box 29776, 2502 LT The Hague, The Netherlands.
E-mail: sparrow{at}iss.nl
This paper looks at targeting performance of the Indonesian health card programme that was implemented in August 1998 to protect access to health care for the poor during the Indonesian economic crisis. By February 1999, 22 million people had received a health card. The health card provided a user fee waiver for public health care. Targeting of the health card was pro-poor, but with considerable leakage to the non-poor. Utilization of the health card for outpatient care was also pro-poor, but conditional on ownership, the middle quintiles were more likely to use the card.
Targeting of the health card followed a decentralized design combining geographic targeting with community-based targeting instruments. This design facilitated the rapid implementation of the programme, but targeting performance suffered from a lack of information on the regional impact of the crisis, while at local level not all barriers to accessing health care services were overcome by the health card. Indirect and direct costs of seeking health care seem to be the main deterrent to using the health card, and are higher in more remote areas.
Micro-simulations show that geographic targeting can contribute considerably to improving targeting performance, but most of the targeting gains are to be made at the local level, with district programme management and public health care providers.
This study highlights the need for adequate and up-to-date social welfare indicators. In addition, further research would need to focus on how local knowledge can be utilized for signalling poverty dynamics and local barriers to access.
Key Words: Access, economic crisis, Indonesia, outpatient care, poverty, price subsidy, targeting
Accepted for publication 16 January 2008.