The Impact of National Health Insurance Program on Household Health Expenditures and Utilization of Health Services in Indonesia

Abstract

Background: Indonesia has implemented social security program through Government-run health insurances through PT. ASKES for civil servants and pensioners, PT. JAMSOSTEK for private employees, provided Community Health Insurance scheme (JAMKESMAS) and Regional Health Insurance (JAMKESDA) for the poor. Since 2014 central government has implemented JKN (jaminan Kesehatan Nasional or National Health Insurance) scheme which basically merged all various government-run social security for health in a single Social Security Agency namely BPJS(Badan Penyelenggara Jaminan Sosial). This study examines the impact of JKN implementation on households health expenditure and health care utilization by comparing before and after the implementation of JKN in 2014 using IFLS (Indonesian Family Live Survey) 2007 and IFLS 2014 data. Method: This study was an analytical study based on quantitative data using two panel data from IFLS (Indonesian Family Life Survey) or IFLS-4 2007dan IFLS-5 2014, by using univariate, bivariate, multivariate regression method and fixed effects regression analysis. Result: Compared to situation in 2007, the implementation of National Health Insurance (JKN) in 2014 had impacted on improving utilization of health care facilities. On the other hand, social determinant factors such as increasing household income, education level of household heads, having family members aged 65 old and above, having children below five years old, increasing health needs in 2014, resulted in increasing household health expenditure in Indonesia. JKN also has no significant impact on reducing catastrophic health expenditure. Conclusion: Health insurance program in Indonesia had significant impacted on increasing utilization of health facilities, but had no significant impacted in reducing household health expenditure in Indonesia.