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Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme

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  • Sparrow, Robert
  • Suryahadi, Asep
  • Widyanti, Wenefrida

Abstract

A first step towards meeting Indonesia's ambition for universal health insurance was made in 2005 with the introduction of the Askeskin programme, a subsidized social health insurance targeted to the informal sector and the poor. This paper investigates targeting and impact of the Askeskin programme using panel data for 8582 households observed in 2005 and 2006, and applying difference-in-differences estimation in combination with propensity score matching. We find that the programme is indeed targeted to the poor and those most vulnerable to catastrophic out-of-pocket health payments. Social health insurance improves access to health care in that it increases utilization of outpatient among the poor, while out-of-pocket spending seems to have increased for Askeskin insured in urban areas.

Suggested Citation

  • Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.
    • Handle: RePEc:eee:socmed:v:96:y:2013:i:c:p:264-271
    DOI: 10.1016/j.socscimed.2012.09.043
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    1. De Weerdt, Joachim & Dercon, Stefan, 2006. "Risk-sharing networks and insurance against illness," Journal of Development Economics, Elsevier, vol. 81(2), pages 337-356, December.
    2. Antonio Trujillo & Jorge Portillo & John Vernon, 2005. "The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching," International Journal of Health Economics and Management, Springer, vol. 5(3), pages 211-239, September.
    3. Kruse, Ioana & Pradhan, Menno & Sparrow, Robert, 2012. "Marginal benefit incidence of public health spending: Evidence from Indonesian sub-national data," Journal of Health Economics, Elsevier, vol. 31(1), pages 147-157.
    4. Alex Arifianto & Ruly Marianti & Sri Budiyati & Ellen Tan, 2005. "Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms (JPK-Gakin) Scheme in Kabupaten Purbalingga, East Sumba, and Tabanan," Development Economics Working Papers 22527, East Asian Bureau of Economic Research.
    5. DiPrete, Thomas A. & Gangl, Markus, 2004. "Assessing bias in the estimation of causal effects: Rosenbaum bounds on matching estimators and instrumental variables estimation with imperfect instruments," Discussion Papers, Research Unit: Labor Market Policy and Employment SP I 2004-101, WZB Berlin Social Science Center.
    6. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    7. Alex Arifianto & Ruly Marianti & Sri Budiyati & Ellen Tan, 2005. "Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms in Kabupaten Tabanan, Bali : A Case Study," Development Economics Working Papers 22523, East Asian Bureau of Economic Research.
    8. Galarrága, O & Sosa-Rubí, S. G & Salinas, A & Sesma, S, 2008. "The Impact of Universal Health Insurance on Catastrophic and Out-of-Pocket Health Expenditures in Mexico: a Model with an Endogoenous Treatment Variable," Health, Econometrics and Data Group (HEDG) Working Papers 08/12, HEDG, c/o Department of Economics, University of York.
    9. Claudia Rokx & George Schieber & Ajay Tandon & Pandu Harimurti & Aparnaa Somanathan, 2009. "Health Financing in Indonesia : A Reform Road Map," World Bank Publications - Books, The World Bank Group, number 2710, December.
    10. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    11. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    12. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
    13. Menno Pradhan & Fadia Saadah & Robert Sparrow, 2007. "Did the Health Card Program Ensure Access to Medical Care for the Poor during Indonesia's Economic Crisis?," The World Bank Economic Review, World Bank, vol. 21(1), pages 125-150.
    14. Adam Wagstaff, 2010. "Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 189-208, February.
    15. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    16. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health‐care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412, December.
    17. Menno Pradhan & Nicholas Prescott, 2002. "Social risk management options for medical care in Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 431-446, July.
    18. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," The World Bank Economic Review, World Bank, vol. 21(1), pages 93-123.
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