BUKTI EMPIRIS KEBIJAKAN ASURANSI KESEHATAN SOSIAL: ANALISIS DATA SURVEI ASPEK KEHIDUPAN RUMAH TANGGA INDONESIA (SAKERTI)

Abstract

Objective: Research that produced empirical evidences for
health policy formulation presumably limited. This article
elaborates this perception by synthesizing four studies on the
demand for outpatient care (OP), e.g., (i) health insurance and
the number of OP visits, social health insurance and (ii) the
use of OP, (iii) providers choices, and (iv) equity in access.
Methods: This study uses data from the second round of the
Indonesian Family Life Survey (IFLS). Two considerations have
been taken into account in selecting estimation methods: the
design of observational study and type of the data used to
measure the demand. To predict the number of OP visits, the
author explored six count data estimators, whilst to investigate
the impact of social insurance on the use of OP, provider
choices, and equity, the author applied a multinomial logistic
regression.
Results: Whilst the distribution of health insurance is
concentrated on the rich, the highest effect of insurance on
access found among the lowest income group. Given provider
alternatives, the insured tend to choose public rather than
private providers. Those who are sicker, not married, wealthier
and highly educated also prefer to use private than public
providers. The impact of social insurance on equity in access
to health care was not observed.
Conclusions: Efforts to increase access to health care
services through a national health insurance (NHI) will be more
effective if the program accommodates consumer preferences.
Changes in the demand from public to private providers must
be taken into account, especially when setting premium subsidy
and benefits baskets of the NHI. In general, the NHI policy has
already empirical evidences. However, NHI implementation
requires a set of technical regulations as a translation of the
National Social Security Act, which also must be supported
from the results of empirical studies.
Keywords: social health insurance, demand for health care,
endogeneity, applied econometrics in health