Abstract
ObjectivesThis study is the first rigorous evaluation of the impact of Jaminan Kesehatan Nasional (JKN) on improving access to outpatient and inpatient care, utilising longitudinal data from the Indonesian Family Life Survey.MethodsTwo treatment groups were identified: a contributory group (N = 982), who paid the premium voluntarily, and a subsidised group (N = 2503), paid by government. Each group was compared with the uninsured group (N = 8576). Propensity score matching combined with difference-in-difference approaches was used to estimate the causal effect of the JKN programme.ResultsThe results found that JKN increased the probability of inpatient admission for the contributory and subsidised groups by 8.2% (95% CI 5.9–10.5%) and 1.8% (95% CI 0.7–2.82%), respectively. The contributory group had an increase in probability of an outpatient visit of 7.9% (95% CI 4.3–11.4%).ConclusionsThe JKN programme has increased the utilisation of outpatient and inpatient care in the contributory group. Those with subsidised insurance have an increase in access to inpatient facilities only, and this is of a smaller magnitude. Hence, while JKN has improved average utilisation, inequity in access to both outpatient and inpatient care may remain.
Highlights
Universal health coverage (UHC) is a key health policy concern in most low- and middle-income countries (LMICs) (Lagomarsino et al 2012; World Health Organization 2014; Maeda et al 2014)
The Jaminan Kesehatan Nasional (JKN) programme has increased the utilisation of outpatient and inpatient care in the contributory group
There are two big groups of JKN enrollees: (1) the subsidised group or Penerima Bantuan Iuran (PBI)/Contribution Assistance Recipients including the poor population and disabled individuals, and (2) the contributory group consisting of Peserta Pekerja Penerima Upah (PPU)/salaried employees, Peserta Pekerja Bukan Penerima Upah (PBPU)/non-salaried workers, and Peserta Bukan Pekerja/non-workers
Summary
Universal health coverage (UHC) is a key health policy concern in most low- and middle-income countries (LMICs) (Lagomarsino et al 2012; World Health Organization 2014; Maeda et al 2014). The inclusion of UHC in the health section of the United Nations Sustainable Development Goals (SDGs) has created renewed momentum for national health insurance schemes (United Nations 2018). It is important for countries introducing or expanding health insurance to learn from experience of other countries, and this study contributes to this important evidence base. Introduced in January 2014, the JKN programme unified several previously fragmented public health insurance, including Askes (which covered public formal sector employees), Jamsostek (private formal sector employees), and Jamkesmas (the poorest population). The difference in inpatient ward classes mostly determines the amount of non-medical facilities, but all patients should receive a similar quality of medical services regardless of the class
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