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" Social Health Insurance to Protect People: A Case Study of the Impact of Indonesia’s National Health Insurance–Jaminan Kesehatan Nasional (JKN) Program "
Kharisma, Dinar Dana
Shepard, Donald S
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Latin Dissertation
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English
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| Record Number
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1053021
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| Doc. No
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TL52138
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| Main Entry
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Kharisma, Dinar Dana
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| Title & Author
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Social Health Insurance to Protect People: A Case Study of the Impact of Indonesia’s National Health Insurance–Jaminan Kesehatan Nasional (JKN) Program\ Kharisma, Dinar DanaShepard, Donald S
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| College
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Brandeis University, The Heller School for Social Policy and Management
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| Date
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2020
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| Degree
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Ph.D.
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| student score
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2020
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| Note
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282 p.
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| Abstract
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Low health care use in Indonesia leads to untreated diseases and reduces the population’s quality of life. While health care use is low, the risk of financial hardship is imminent. Excessive medical spending is estimated to raise the poverty rate by up to 29%. To address these problems, the government launched the single-payer Jaminan Kesehatan Nasional (JKN) insurance program in 2014. Replacing the previously fragmented insurance programs, JKN offers a comprehensive benefits package, expanded coverage, and a more extensive network of private health care facilities. However, JKN initiation effectively terminated a universal free maternal health care program, JAMPERSAL. This dissertation explored whether JKN has increased the user rate of outpatient and inpatient care in various health facilities, restricted uninsured mothers' access to skilled birth attendants, and averted households' catastrophic expenditures and impoverishment. This study applied a mixed-methods design, analyzing the National Socioeconomic Survey (SUSENAS) of 2011-2017 and qualitative data from interviews. To address health insurance’s endogeneity when estimating insurance impacts, the study employed the difference-in-difference and instrumental variable approaches. The study also conducted qualitative data collection through interviews with JKN stakeholders, including policymakers, the JKN implementing agency, health facilities, and patients. The research finds that insurance increased the probability of accessing outpatient and inpatient care. However, the insurance impact post JKN was significantly lower compared to its impact pre JKN, suggesting JKN’s underperformance compared to the previous programs. After JKN, health insurance has been successful in increasing hospital use, especially for outpatient care. However, JKN’s close link with public facilities shifted utilization away from private facilities. The research confirms that the discontinuation of JAMPERSAL has reduced uninsured mothers’ access to skilled birth attendants. This study also finds that JKN has been slightly more effective in protecting the insured from catastrophic health spending and impoverishment than the previous programs. The interview results suggest that JKN’s association with lower quality health care has reduced the program’s impact. Parallel changes, such as the national health budget expansion, potentially made medical care more affordable and further attenuated the impact of insurance on health care use. The study also noted health facilities’ complaints regarding JKN’s onerous paperwork and delayed payment, which limited the facilities’ ability to serve and protect JKN members. The study recommends that JKN improve its compensation scheme to health facilities, strengthen primary care, and support the private sector to prevent quality decline and expand service availability. Policymakers need to consider reviewing JKN’s premium rate and benefits package to enhance the program’s financial sustainability. Finally, to reach underserved population groups, additional government spending on public health is needed, especially to develop a stronger outreach program to the poor as well as to improve facility and health worker availability in remote areas.
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| Descriptor
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Public health
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Public policy
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| Added Entry
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Shepard, Donald S
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| Added Entry
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Brandeis University, The Heller School for Social Policy and Management
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