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Does universal health insurance program against burden of catastrophic health expenditure in Indonesia?: Markov modeling with a lifespan perspective using IFLS 2007 and 2014
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2017 (English)Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Aims: Health insurances have been recommended as a solution to reduce the burden of catastrophic health expenditure. Indonesia, started implementing national social health insurance program named Jaminan Kesehatan Nasional (JKN) since January 1, 2014 and aiming for universal health coverage by 2019. There is a lack of knowledge on the effectiveness of the JKN to reduce catastrophic health expenditure burden in Indonesia. The objectives of this study, therefore, are to examine the effect of the health insurance program in reducing the catastrophic health expenditure and examine the cost effectiveness of health insurance in improving health.

Methods: Regression analysis using multiple linear and logistic regression, IV regression, and fixed effect model were performed to investigate the effect of health insurance towards catastrophic health expenditure. A Markov model with four states of not catastrophe, catastrophe, impoverishment, and death was built based on RAND Indonesian Family Life Survey (IFLS) to examine the cost effectiveness of health insurance program. The outcome variable was defined as life years gained associated with providing health insurance to uninsured populations. The costs parameter were derived from the average costs in each state and the health insurance premium costs. Markov deterministic decision model was performed to calculate Incremental cost effectiveness ratios (ICER) using 3% discount rate.

Results: Health insurance showed a protective effect against impoverishment but surprisingly increases the amount of out of pocket health expenditure by insured individuals. Expanding health insurance to 20-year-olds uninsured populations in Indonesia was cost-effective (ICER US$813.37/LY gained) compared to the national threshold GDP per capita. The effectiveness varied between age-sex groups and socioeconomic status. The ICER of providing the health insurance among women was more favorable compared to men. Lower education status and low-income quintile group also had the lower ICER indicating to be more cost-effective target group of expanding health insurance compared to the higher education status and high-income quintile.

Conclusion: Providing health insurance to the uninsured was cost-effective in Indonesia. Government should continue to broaden the coverage of health insurance in general populations and pays attention to the more vulnerable group (lower socioeconomic status) on reaching the universal health coverage target.

Place, publisher, year, edition, pages
2017. , p. 26
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2017:32
Keywords [en]
cost effectiveness, health insurance, catastrophic health expenditure, impoverishment, out of pocket health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-142712OAI: oai:DiVA.org:umu-142712DiVA, id: diva2:1163947
External cooperation
Indonesian Family Life Survey - Rand Corporation
Educational program
Master's Programme in Public Health
Presentation
2017-05-22, Room 933, 9th floor, Dentistry building, Umeå University Hospital, Umeå, 14:00 (English)
Supervisors
Examiners
Available from: 2017-12-19 Created: 2017-12-08 Last updated: 2017-12-19Bibliographically approved

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CiteExportLink to record
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Citation style
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