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


  • Menno Pradhan
  • Fadia Saadah
  • Robert Sparrow


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.

Suggested Citation

  • 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?," World Bank Economic Review, World Bank Group, vol. 21(1), pages 125-150.
  • Handle: RePEc:oup:wbecrv:v:21:y:2007:i:1:p:125-150

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    References listed on IDEAS

    1. Duncan Thomas & James P. Smith & Kathleen Beegle & Graciela Teruel & Elizabeth Frankenberg, 2002. "Wages, employment and economic shocks: Evidence from Indonesia," Journal of Population Economics, Springer;European Society for Population Economics, vol. 15(1), pages 161-193.
    2. Emmanuel Skoufias & Asep Suryahadi, 2000. "Changes in Household Welfare, Poverty and Inequality During the Crisis," Bulletin of Indonesian Economic Studies, Taylor & Francis Journals, vol. 36(2), pages 97-114.
    3. David E. Sahn & Stephen D. Younger & Garance Genicot, 2003. "The Demand for Health Care Services in Rural Tanzania," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 65(2), pages 241-260, May.
    4. Winnie Yip & Peter Berman, 2001. "Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 207-220.
    5. Asep Suryahadi & Sudarno Sumarto & Lant Pritchett, 2003. "Evolution of Poverty During the Crisis in Indonesia," Asian Economic Journal, East Asian Economic Association, vol. 17(3), pages 221-241, September.
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    Cited by:

    1. Chris Elbers & Jan Willem Gunning & Kobus de Hoop, 2007. "Assessing Budget Support with Statistical Impact Evaluation: a Methodological Proposal," Tinbergen Institute Discussion Papers 07-075/2, Tinbergen Institute, revised 31 Dec 2007.
    2. Giles, John & Satriawan, Elan, 2015. "Protecting child nutritional status in the aftermath of a financial crisis: Evidence from Indonesia," Journal of Development Economics, Elsevier, vol. 114(C), pages 97-106.
    3. World Bank, 2006. "Making the New Indonesia Work for the Poor," World Bank Other Operational Studies 8172, The World Bank.
    4. repec:jet:dpaper:dpaper391 is not listed on IDEAS
    5. 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.
    6. Cavagnero, Eleonora & Bilger, Marcel, 2010. "Equity during an economic crisis: Financing of the Argentine health system," Journal of Health Economics, Elsevier, vol. 29(4), pages 479-488, July.
    7. 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.
    8. Erlyana, Erlyana & Damrongplasit, Kannika Kampanya & Melnick, Glenn, 2011. "Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?," Health Policy, Elsevier, vol. 100(2), pages 273-281.
    9. Johar, Meliyanni, 2010. "The effect of a public health card program on the supply of health care," Social Science & Medicine, Elsevier, vol. 70(10), pages 1527-1535, May.
    10. Johar, Meliyanni, 2009. "The impact of the Indonesian health card program: A matching estimator approach," Journal of Health Economics, Elsevier, vol. 28(1), pages 35-53, January.
    11. Robert Sparrow & Ellen Van de Poel & Gracia Hadiwidjaja & Athia Yumna & Nila Warda & Asep Suryahadi, 2012. "Financial Consequences of Ill Health and Informal Coping Mechanisms in Indonesia," Departmental Working Papers 2012-07, The Australian National University, Arndt-Corden Department of Economics.
    12. Hidayat, Budi, 2007. "Are there differences between unconditional and conditional demand estimates? implications for future research and policy," MPRA Paper 30196, University Library of Munich, Germany.
    13. Elbers, Chris & Gunning, Jan Willem & de Hoop, Kobus, 2009. "Assessing Sector-wide Programs with Statistical Impact Evaluation: A Methodological Proposal," World Development, Elsevier, vol. 37(2), pages 513-520, February.
    14. Liu, Dan & Tsegai, Daniel W., 2011. "The New Cooperative Medical Scheme (NCMS) and its implications for access to health care and medical expenditure: Evidence from rural China," Discussion Papers 116746, University of Bonn, Center for Development Research (ZEF).
    15. Samarakoon, Shanika & Parinduri, Rasyad, 2015. "Social health insurance improves women’s healthcare use: Evidence from Indonesia," MPRA Paper 61504, University Library of Munich, Germany.
    16. Palmer, Michael & Mitra, Sophie & Mont, Daniel & Groce, Nora, 2015. "The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach," Social Science & Medicine, Elsevier, vol. 145(C), pages 217-226.
    17. Nguyen, Ha & Knowles, James, 2010. "Demand for voluntary health insurance in developing countries: The case of Vietnam's school-age children and adolescent student health insurance program," Social Science & Medicine, Elsevier, vol. 71(12), pages 2074-2082, December.

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