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All Journal Jurnal Perencanaan Pembangunan Bappenas Working Papers
Dinar Dana Kharisma
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Healthcare Access Inequity within a Social Health Insurance Setting: A Risk Faced by Indonesia’s Jaminan Kesehatan Nasional (JKN) Program Dinar Dana Kharisma
Bappenas Working Papers Vol 3 No 1 (2020): Maret 2020
Publisher : Kementerian Perencanaan Pembangunan Nasional (Bappenas)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47266/bwp.v3i1.56

Abstract

This paper is a literature review laying out empirical evidence of healthcare access inequity within an implementation of social health insurance (SHI) programs. The research question of this paper is: in what way, and how, inequity in healthcare access potentially happens, even if a type of SHI covers the whole, or most, of a society. This paper is mainly motivated by the implementation of Jaminan Kesehatan Nasional (JKN), an SHI program in Indonesia. Even though the program aims to create better equity in healthcare access, the existing health system and the program’s design may prevent the achievement of this goal. By laying out evidence on how healthcare access inequity in other countries remains within an SHI mechanism, this paper illuminates that JKN may face the same risk. In reviewing the papers, this study applied Goddard and Smith’s (2001) concept of healthcare access inequity in the area of availability, quality, cost, and information. The findings suggest that healthcare access inequity could happen despite the implementation of an SHI program. Four types of circumstances that might have led to healthcare access inequity include geographical disparities of health facilities; adequacy of insurance program’s reimbursement and healthcare providers’ financial motive; healthcare providers’ prejudices toward patients; and unequal personal advantages of health treatment seekers. When applied to the context of JKN implementation in Indonesia, the risks of healthcare access inequity are imminent, mostly due to the uneven concentration of health facilities, the program’s segmented tariff rates, and the socioeconomic diversity among JKN members. The findings imply that JKN members might be at risk of healthcare access inequity. While the risks are plausible, this study is limited to predicting the potential inequity within JKN, mirroring from the empirical evidence. This study signifies the need for further empirical research on this area, which will potentially inform policymakers to improve the program.
Indonesian Health System Performance Assessment: The Association between Health Insurance Expansion with Health Status and Health Care Access Dinar Dana Kharisma
Jurnal Perencanaan Pembangunan: The Indonesian Journal of Development Planning Vol. 4 No. 3 (2020): September 2020
Publisher : Ministry of National Development Planning Republic of Indonesia/Bappenas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36574/jpp.v4i3.134

Abstract

This paper analyzes health outcomes and inequality in Indonesia, and the links to intermediate factors and inputs. Between 1997-2015, the country's health performance indicators had improved and became more equal. This achievement could potentially be correlated with improvement in health care access, which might be a result of the Indonesian government's policy to expand health insurance coverage, mainly to the most impoverished population. By 2020, the Indonesian government operates national social health insurance, the Jaminan Kesehatan Nasional (JKN), which covers about 83% of the country's population, including the poor and vulnerable. This paper uses the Control Knob Framework and focuses on the health insurance expansion as the financing knob adjustment conducted by the government. The analysis starts with the improvement of health status indicators and tracks back its association with health care access and health insurance coverage expansion. This paper finds that health status improvement in Indonesia between 1997-2015 was correlated with health care access increase. The decline in the infant mortality rate (IMR) and the under-five mortality rate (U5MR) between 1997-2015 were associated with an increase in health care utilization, including the use of trained birth attendants and diphtheria-pertussis-tetanus (DPT) immunization. This paper then observes a strong correlation between the expansion of health care access and health insurance coverage. In terms of equality, the article sees a weaker, but evident, correlation between health insurance equalization across different population groups with more equitable health care access and health outcomes. The findings of this paper justify the effectiveness of the financing knob (expanding and equalizing health insurance coverage) in increasing access to care (outpatient and inpatient care, trained birth attendants, immunization) and improving health status (IMR and U5MR). This study is among the firsts to utilize Control Knob Framework as an analytical tool for health insurance assessment. The study recommends the government to combine health insurance expansion with other progressive policy, such as financial support to poor patients to cover the non-medical expenses of attending health care, to optimize the effectiveness of the interventions.
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