Abstract
The maternal mortality rate in Indonesia is still high, at 305 per 100,000 live births. Several studies indicated maternal financial burden as one of the dimensions of access that influence a pregnant woman’s ability to receive adequate, high-quality medical care. This study aims to identify the association between the use of Indonesia’s national health insurance (JKN) and out-of-pocket (OOP) expenditures in accessing delivery services, using data from the Indonesian Family Life Survey 5. In addition, this study also investigated the relationship of JKN and the potential reduction of catastrophic delivery expenditures (CDEs) for delivery services. The results show that JKN was associated with reduced OOP expenditures for delivery as well as reduced risk of incurring CDE. However, some OOP expenditure for cost of delivery services still exists among mothers who used JKN during delivery, potentially due to factors such as medicine stock availability and inpatient care shortages.
Highlights
In 2015, the Indonesian maternal mortality ratio (MMR) was 305 per 100,000 live births, according to the Intercensal Population Survey (SUPAS) 2015, [1] which was far from the Sustainable Development Goals (SDGs) target of 70 deaths per 100,000 live births in 2030 [2]
This study aims to address the gap in the literature on OOP expenditure for delivery services and the risk of catastrophic delivery expenditures (CDEs) in Indonesia
Our findings may be summarized as follows: first, our results indicate that mothers still needed to pay OOP for delivery even though they use Jaminan Kesehatan Nasional (JKN) insurance; second, the used of JKN for delivery was significantly associated with the reduction of both the amount of OOP expenditures for delivery services and the risk of CDE; and third, JKN may still face implementation challenges because the poorest group does not utilize it optimally
Summary
In 2015, the Indonesian maternal mortality ratio (MMR) was 305 per 100,000 live births, according to the Intercensal Population Survey (SUPAS) 2015, [1] which was far from the Sustainable Development Goals (SDGs) target of 70 deaths per 100,000 live births in 2030 [2]. Thaddeus and Maine (1994) developed the “Three Delays Models” framework that describes the causes of maternal mortality, which include: (1) the delay in deciding to seek care, (2) the delay in reaching an adequate healthcare facility, and (3) the delay in receiving adequate care once at the health facility [3]. They noted that the second delay was closely related to the financial burden mothers may face during delivery. Evidence indicates that high OOP expenditures increase the risk of a household’s risk to experience catastrophic financial conditions [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
