Author:
Fattah Rifqi Abdul,Cheng Qinglu,Thabrany Hasbullah,Susilo Dwidjo,Satrya Aryana,Haemmerli Manon,Kosen Soewarta,Novitasari Danty,Puteri Gemala Chairunnisa,Adawiyah Eviati,Hayen Andrew,Gilson Lucy,Mills Anne,Tangcharoensathien Viroj,Jan Stephen,Asante Augustine,Wiseman Virginia
Abstract
Abstract
Background
Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%.
Methods
This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted.
Results
The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities.
Conclusions
This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference38 articles.
1. United Nations. Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development New York: United Nations. ; 2023 [Available from: https://unstats.un.org/sdgs/indicators/indicators-list/.
2. World Health Organization. The world health report: health systems financing: the path to universal coverage Geneva: World Health Organization; 2010 [updated 2010. Available from: https://apps.who.int/iris/handle/10665/44371.
3. United Nations. UN High-Level Meeting on Universal Health Coverage 2019 2019 [Available from: https://www.un.org/pga/73/event/universal-health-coverage/.
4. Wagstaff A, Eozenou P, Smitz M. Out-of-Pocket Expenditures on Health: A Global Stocktake. World Bank Res Obs. 2020;35(2):123–57.
5. World Health Organization, the International Bank for Reconstruction and Development/the World Bank. Tracking universal health coverage: 2021 Global Monitoring Report 2021 [Conference Edition:[Available from: https://www.who.int/publications/i/item/9789240040618.