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Did the Health Card Program Ensure Access to Medical Care for the Poor during Indonesia's Economic Crisis?

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Author Info
Menno Pradhan
Fadia Saadah
Robert Sparrow

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Abstract

The Indonesian Social Safety Net health card program was implemented in response to the economic crisis that hit Indonesia in 1997, to preserve access to health care services for the poor. Health cards were allocated to poor households, entitling them to subsidized care from public health care providers. The providers received budgetary support to compensate for the extra demand. This article focuses on the effect of the program on primary outpatient health care use, disentangling the direct effect of allocating health cards from the indirect effect of government transfers to health care facilities. For poor health card owners the program resulted in a net increase in use of outpatient care, while for nonpoor health card owners the program resulted mainly in a substitution from private to public health care. The largest effect of the program seems to have come from a general increase in the supply of public services resulting from the budgetary support to public providers. These benefits seem to have been captured mainly by the nonpoor. As a result, most of the benefits of the health card program went to the nonpoor, even though distribution of the health cards was propoor. The results suggest that had the program, in addition to targeting the poor, established a closer link between provision of services to the target groups and funding, the overall results would have been more propoor. Copyright 2007, Oxford University Press.

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Publisher Info
Article provided by Oxford University Press in its journal The World Bank Economic Review.

Volume (Year): 21 (2007)
Issue (Month): 1 ()
Pages: 125-150
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Handle: RePEc:oup:wbecrv:v:21:y:2007:i:1:p:125-150

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Lisa Cameron, 1999. "Survey of Recent Developments," Bulletin of Indonesian Economic Studies, Taylor and Francis Journals, vol. 35(1), pages 3-41, April. [Downloadable!] (restricted)
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    Other versions:
  3. Currie, J. & Thomas, D., 1995. "Medical Care for Children, Public Insurance, Private Insurance, and Racial Differences in Utilization," Papers 95-08, RAND - Reprint Series.
  4. Currie, Janet & Gruber, Jonathan, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 431-66, May. [Downloadable!] (restricted)
    Other versions:
  5. H. Naci Mocan & Erdal Tekin & Jeffrey S. Zax, 2000. "The Demand for Medical Care in Urban China," NBER Working Papers 7673, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  6. Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987. "Are user fees regressive? : The welfare implications of health care financing proposals in Peru," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 67-88. [Downloadable!] (restricted)
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  14. Heckman, James J & Ichimura, Hidehiko & Todd, Petra E, 1997. "Matching as an Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," Review of Economic Studies, Blackwell Publishing, vol. 64(4), pages 605-54, October. [Downloadable!] (restricted)
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  17. Rajeev H. Dehejia & Sadek Wahba, 1998. "Causal Effects in Non-Experimental Studies: Re-Evaluating the Evaluation of Training Programs," NBER Working Papers 6586, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  23. Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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    Other versions:
  25. Jimenez, Emmanuel, 1995. "Human and physical infrastructure: Public investment and pricing policies in developing countries," Handbook of Development Economics, in: Hollis Chenery† & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 3, chapter 43, pages 2773-2843 Elsevier. [Downloadable!] (restricted)
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  28. Guido W. Imbens, 2003. "Nonparametric Estimation of Average Treatment Effects under Exogeneity: A Review," NBER Technical Working Papers 0294, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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Full references

Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Ari A. Perdana & John Maxwell, 2004. "Poverty Targeting in Indonesia - Programs, Problems and Lessons Learned," Development Economics Working Papers 68, East Asian Bureau of Economic Research. [Downloadable!]
    Other versions:
  2. Somanathan, Aparnaa, 2008. "The impact of price subsidies on child health care use : evaluation of the Indonesian healthcard," Policy Research Working Paper Series 4622, The World Bank. [Downloadable!]
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This page was last updated on 2009-11-19.

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