Main Article Content
Abstract
Catastrophic expenditure, defined as health care expenditure exceeding 10% of household income, remains prevalent in eastern Indonesia, highlighting the urgent need for targeted health policy and infrastructure interventions. This study investigates the impact of the Community Health Insurance Scheme (Jamkesmas) in reducing catastrophic healthcare expenditure in eastern Indonesia offering a new perspective by focusing on areas with lower Universal Health Coverage (UHC) and higher poverty rates. Using data from the 2012 Eastern Indonesia Family Life Survey covering a sample of 1,105 working-age individuals, logit and probit regression methods were applied. The findings revealed that Jamkesmas significantly reduced the likelihood of catastrophic health care expenditure, with effectiveness 1.8 times higher than that of individuals without health insurance. Exogenous factors such as age, urban residence, male gender, and marital status further supported this reduction. In contrast, barriers such as long distances to health facilities and limited knowledge of public hospitals increased the risk of catastrophic expenditure among workers. These results underscore the importance of expanding access to health services and improving the implementation of Jamkesmas in eastern Indonesia. By addressing disparities in health insurance coverage and healthcare facility distribution, the government can better mitigate catastrophic expenditures, supporting the achievement of the demographic bonus by 2045.
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References
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- Gotsadze, T., Zoidze, A., Rukhadze, N., Shengelia, N., & Chkhaidze, N. (2015). An Impact Evaluation of Medical Insurance for poor in Georgia: preliminary results and policy implications. Health Policy Plan, 30(1), 1-13. https://doi.org/10.1093/heapol/czu095
- Groth, H., & May, J. F. (Eds.). (2017). Africa's Population: In Search of a Demographic Dividend. Springer. https://doi.org/10.1007/978-3-319-46889-1
- Gujarati, D. (2004). Basic Econometrics (4th Edition). New York: McGraw-Hill.
- Herawati, Franzone, R., Chrisnahutama, A. (2020). Universal Health Coverage: Tracking Indonesia’s Progress. Jakarta: Perkumpulan PRAKARSA.
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- Sikoki, B., Witoelar, F., Straus, J., Meijer, E., & Suriastini, W. (2013). IFLS East User’s Guide and Field Report. SurveyMETER.
- Social Security Administrating Agency of Health. 2022. JKN Statistics 2016-2021. Badan Penyelenggara Jaminan Sosial Kesehatan. Retrieved from https://djsn.go.id/files/dokumen
- Social Security Administrating Agency of Health. 2023. National Health Insurance Participant Data. Badan Penyelenggara Jaminan Sosial Kesehatan. Retrieved from https://data.bpjs-kesehatan.go.id
- Solida, A., Noerjoedianto, D., Mekarisce, A. A., & Widiastuti, F. (2021). Pola Belanja Kesehatan Katastropik Peserta Jaminan Kesehatan di Kota Jambi. Jurnal Kebijakan Kesehatan Indonesia, 10(4), 209-215. https://doi.org/10.22146/jkki.68736
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- Statistics Indonesia. 2023. Population by Age Group and Gender. Central Bureau of Statistics. Retrieved from https://www.bps.go.id
- Utami, A., N., F. & Mutiarin, D. (2016). Evaluasi Program Jaminan Kesehatan Nasional pada Fasilitas Kesehatan Tingkat I Kabupaten Sleman Tahun 2016. Journal of Governance and Public Policy, 4(1), 39-70. https://doi.org/10.18196/jgpp.v4i1.2641
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References
Aji, B., Mohammed, S., Haque, M. A., & Allegri, M. D. (2017). The dynamics of catastrophic and impoverishing health spending in Indonesia: how well does the Indonesian health care financing system perform?. Asia Pacific Journal of Public Health, 29(6), 506-515. https://doi.org/10.1177/1010539517729778
Fattah, R.A., Cheng, Q., Thabrany, H., Susilo, D., Satrya, A., Haemmerli, M., Kosen, Soewarta., Novitasari, D., Puteri, G.C., Adawiyah, E., Hayen, A., Gilson, L., Mills, A., Tangcharoensanthien, V., Jan, S., Asante, A., Wiseman, V. (2023). Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019. International Journal for Equity in Health, 22(185), 1-12. https://doi.org/10.1186%2Fs12939-023-01980-w
Gotsadze, T., Zoidze, A., Rukhadze, N., Shengelia, N., & Chkhaidze, N. (2015). An Impact Evaluation of Medical Insurance for poor in Georgia: preliminary results and policy implications. Health Policy Plan, 30(1), 1-13. https://doi.org/10.1093/heapol/czu095
Groth, H., & May, J. F. (Eds.). (2017). Africa's Population: In Search of a Demographic Dividend. Springer. https://doi.org/10.1007/978-3-319-46889-1
Gujarati, D. (2004). Basic Econometrics (4th Edition). New York: McGraw-Hill.
Herawati, Franzone, R., Chrisnahutama, A. (2020). Universal Health Coverage: Tracking Indonesia’s Progress. Jakarta: Perkumpulan PRAKARSA.
Horgan, D. R., Stevens, G. A., Hosseinpoor, A. R., & Boerma, T. (2017). Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. The Lancet Global Health, 6(2), e152-e168. https://doi.org/10.1016/S2214-109X(17)30472-2
Husna, A., & Sukartini, N. M. (2021). Determinants of Catastrophic Health Expenditure (CHE): An Indonesian Family Life Survey (IFLS) 2007 & 2014. Journal of Economic, Business, & Accountary Ventura, 24(1), 156-170. http://orcid.org/0000-0001-9421-7822
Karan, A., Yip, W., & Mahal, A. (2017). Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out-of-pocket spending for healthcare. Social Science & Medicine, 181, 83-92. https://doi.org/10.1016/j.socscimed.2017.03.053
Ministry of Health. 2022. Annual Report of the Ministry of Health. Ministry of Health. Retrieved from https://ditjen-nakes.kemkes.go.id
Newey, W. K. (1987). Efficient estimation of limited dependent variable models with endogenous explanatory variables. Journal of Econometrics, 36(3), 231–250. https://doi.org/10.1016/0304-4076(87)90001-7
Nugraheni, W. P. & Hartono, R. K. (2017). Determinan Pengeluaran Kesehatan Katastropik Rumah Tangga Indonesia pada Tahun Pertama Implementasi Program JKN. Buletin Penelitian Kesehatan, 45(1), 27-36. http://dx.doi.org/10.22435/bpk.v45i1.6069.27-36
Opeloyeru, O. S. & Lawanson, A. O. (2023). Determinants of catastrophic household health expenditure in Nigeria. International Journal of Social Economics, 50(6), 876-892. https://doi.org/10.1108/IJSE-02-2022-0132
Quattrochi, J. P., Hill, K., Salomon, J. A., & Castro, M. C. (2020). The effects of changes in distance to the nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980–1998. BMC Health Services Research, 20(899). 1-12. https://doi.org/10.1186/s12913-020-05738-w
Rahman, T. Gasbarro, D., Alam, K., & Alam, K. (2024). Rural-urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis. International Journal for Equity in Health, 23, 43. https://doi.org/10.1186/s12939-024-02125-3
Reid, M., Gupta, R., Roberts, G., Goosby, E., & Wesson, P. (2020). Achieving Universal Health Coverage (UHC): Dominance analysis across 183 countries highlights importance of strengthening health workforce. PloS one, 15(3), e0229666. https://doi.org/10.1371/journal. pone.0229666
Rinasih, R. (2019). Reform of the System of Public Health Insurance for the Poor in Indonesia Has Opportunity to Increase Health Inequality: Considering Different Accessibility of Puskesmas. Jurnal Info Artha, 2(3), 101-118. https://doi.org/10.31092/jia.v3i2.584
Rolindrawan, D. (2015). The Impact of BPJS Health Implementation for the Poor and Near Poor on the Use of Health Facility. Procedia-Social and Behavioral Sciences, 211, 550-559. http://dx.doi.org/10.1016/j.sbspro.2015.11.073
Satibi, S., Andayani, T. M., Endarti, D., Suwantara, I. P. T., Wintariani, N. P., & Agustini, N. P. D. (2019). Comparison of real cost versus the Indonesian case base groups (INA-CBGs) tariff rates among patients of high-incidence cancers under the National health insurance scheme. Asian Pacific Journal Cancer Prevention, 20(1), 117–22. https://doi.org/10.31557%2FAPJCP.2019.20.1.117
Sikoki, B., Witoelar, F., Straus, J., Meijer, E., & Suriastini, W. (2013). IFLS East User’s Guide and Field Report. SurveyMETER.
Social Security Administrating Agency of Health. 2022. JKN Statistics 2016-2021. Badan Penyelenggara Jaminan Sosial Kesehatan. Retrieved from https://djsn.go.id/files/dokumen
Social Security Administrating Agency of Health. 2023. National Health Insurance Participant Data. Badan Penyelenggara Jaminan Sosial Kesehatan. Retrieved from https://data.bpjs-kesehatan.go.id
Solida, A., Noerjoedianto, D., Mekarisce, A. A., & Widiastuti, F. (2021). Pola Belanja Kesehatan Katastropik Peserta Jaminan Kesehatan di Kota Jambi. Jurnal Kebijakan Kesehatan Indonesia, 10(4), 209-215. https://doi.org/10.22146/jkki.68736
Sparrow, R., Suryahadi, A., & Widyanti, W. (2013). Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin program. Social Science & Medicine, 96, 264–271. https://doi.org/10.1016/j.socscimed.2012.09.043
Statistics Indonesia. 2018. Percentage of Poor Population by Province. Central Bureau of Statistics. Retrieved from http://sensus.bps.go.id/topik/tabular/sp2022/188?share=1
Statistics Indonesia. 2023. Population by Age Group and Gender. Central Bureau of Statistics. Retrieved from https://www.bps.go.id
Utami, A., N., F. & Mutiarin, D. (2016). Evaluasi Program Jaminan Kesehatan Nasional pada Fasilitas Kesehatan Tingkat I Kabupaten Sleman Tahun 2016. Journal of Governance and Public Policy, 4(1), 39-70. https://doi.org/10.18196/jgpp.v4i1.2641
Wagstaff, A., Flores, G., Hsu, J. Smitz, M., Chepynoga, K., Buisman, L. R., Wilgenburg, K. V., & Eozenou, P. (2018). Progress on catastrophic health spending in 133 countries: a retrospective observational study. The Lancet Global Health, 6(2), e169-e179. https://doi.org/10.1016/ s2214-109x(17)30429-1
Wooldridge, J. M. (2010). Econometric Analysis of Cross Section and Panel Data. Cambridge. The MIT Press.
Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: A multicountry analysis. The Lancet, 362(9378), 111–117. https://doi.org/10.1016/s0140-6736(03)13861-5