Studi ini mengukur bagaimana ketersediaan infrastruktur kesehatan memengaruhi efek asuransi kesehatan nasional terhadap pemanfaatan layanan kesehatan saat ketersediaan infrastruktur kesehatan rendah, dengan mengambil kasus Indonesia. Dengan menggunakan difference-in-differences (DID) dan difference-in-differences-in-differences (DDD), penelitian ini menganalisis data panel pemanfaatan layanan kesehatan di 514 kabupaten kota dan 34 provinsi di Indonesia selama periode 2009-2017. Kami menemukan bahwa efek Program Jaminan Kesehatan Nasional (JKN) yang diterapkan di Indonesia sejak tahun 2014 terhadap pemanfaatan layanan kesehatan lebih rendah pada kabupaten-kabupaten dan provinsi-provinsi yang memiliki ketersediaan infrastruktur kesehatan, yaitu puskesmas dan rumah sakit, yang rendah, dan hasil ini signifikan pada tingkat 5%. Selanjutnya, efek JKN tersebut ditemukan lebih rendah lagi pada saat daerah yang memiliki ketersediaan infrastruktur kesehatan rendah juga memiliki rasio penduduk miskin yang tinggi, menunjukkan bahwa kelangkaan infrastruktur kesehatan sangat membatasi akses penduduk miskin terhadap JKN. Temuan ini mendukung literatur yang ada menjelaskan bahwa ketersediaan infrastruktur kesehatan menentukan efektivitas kebijakan asuransi kesehatan nasional dalam memberikan layanan.
This study measures how the availability of health infrastructure influences the effects of the national health insurance on the utilization of health services, taking the case of Indonesia. By using a difference-in-differences (DID) and difference-in-differences-in-differences (DDD), this study analyzes the panel data of health service utilization in 514 municipal districts and 34 provinces in Indonesia during the 2009-2017. We find that the effects of the national health insurance on the utilization of health services are lower in the districts and provinces where the availability of health infrastructures, i.e. public health centers and hospitals, are low, and these results are significant at 5% level. Moreover, the effects of JKN are also lower in the areas where the availability of health infrastructure is low and the poverty level is high, showing that the lack of health infrastructure has limited the access of the poor to JKN. These findings support the existing literature explaining that the availability of health infrastructure would determine the effectiveness of national health insurance in delivering services.
"Kata kunci: Out-of-pocket health expenditure, asuransi kesehatan, kemiskinan, Universal Health Coverage (UHC)
Nowadays, people are becoming more aware of the importance of having access to healthcare. Unfortunately, healthcare costs are getting more expensive due to medical inflation, which is generally higher than economic inflation. Having out-of-pocket health expenditures is driving some people to be in poverty. However, some findings find that increasing coverage of health insurance might contribute to poverty reduction. This study aims to study the effect of out-of-pocket (OOP) health expenditures and health insurance ownership on poverty in Indonesia, focusing on its correlation. Moreover, this study aims to analyze the strengths, weaknesses, opportunities, and threats of health insurance companies in achieving 100% coverage and contributing to UHC (Universal Health Coverage). For the analysis, this study adopts quantitative and qualitative study. Quantitative analysis uses data from Susenas 2019-2021 and methodology Logistic regression. Qualitative analysis uses primary research using in-depth interviews and consumer surveys. The study found that OOP health expenditure and poverty have a negative correlation, which means a decrease in OOP health expenditure is not significant in reducing poverty because those who have higher OOP health expenditure are the non-poor. This study also found that health insurance ownership and poverty have a negative correlation, which means it is proven that owning health insurance is significant in reducing poverty. This shows that it is important for Indonesia to reach 100% health insurance coverage to ensure all people are covered with basic necessary healthcare access.
Keywords: Out-of-pocket health expenditure, health insurance, poverty, Universal Health Coverage (UHC)"