This article identifies the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. The article places the findings in the context of a framework showing the complex cause and effect relationships underlying the effects of economic downturns on health and health care. The results are based on primary analysis of Indonesian household survey data and review of a wide range of sources from the Indonesian government and international organizations. Comparisons are drawn with the effects of the crisis in Thailand. The devaluation of the Indonesian currency, the Rupiah, led to inflation and reduced real public expenditures on health. Households' expenditures on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported morbidity increased sharply from 1997 to 1998 in both rural and urban areas of Indonesia. The crisis led to a substantial reduction in health service utilization during the same time period, as the proportion of household survey respondents reporting an illness or injury that sought care from a modern health care provider declined by 25%. In contrast to Indonesia, health care utilization in Thailand actually increased during the crisis, corresponding to expansion in health insurance coverage. The results suggest that social protection programmes play a critical role in protecting populations against the adverse effects of economic downturns on health and health care.

Disparities among social and economic groups have narrowed over time in Indonesia; the relatively high risk of male children compared with females has also decreased. Maternal education and economic status-as measured by quintile of adjusted per-capita household expenditures-have continued to be very strong predictors of children's nutritional outcomes.

The Indonesian Healthcard program was implemented in response to the economic crisis, which hit Indonesia in 1998, in order to preserve access to health care services for the poor. The Healthcard provided the households with subsidised care at public health care providers, while the providers themselves received budgetary support to compensate for the extra demand. This papers looks at the impact of this program on outpatient care utilisation, and, in particular, endeavours to disentangle the direct effect of the allocation of Healthcards from the indirect effect of the transfer of funds to health care facilities. It finds that the program resulted in a net increase in utilisation for the poor beneficiaries. For non-poor beneficiaries the program resulted in a substitution from private to public providers only. However, the largest effect of the program seems to have come from a general increase in the quality of public services resulting from the budgetary support they received through this program.

No abstract

The Indonesian Healthcard program was implemented in response to the economic crisis, which hit Indonesia in 1998, in order to preserve access to health care services for the poor. The Healthcard provided the households with subsidised care at public health care providers, while the providers themselves received budgetary support to compensate for the extra demand. This papers looks at the impact of this program on outpatient care utilisation, and, in particular, endeavours to disentangle the direct effect of the allocation of Healthcards from the indirect effect of the transfer of funds to health care facilities. It finds that the program resulted in a net increase in utilisation for the poor beneficiaries. For non-poor beneficiaries the program resulted in a substitution from private to public providers only. However, the largest effect of the program seems to have come from a general increase in the quality of public services resulting from the budgetary support they received through this program.

No abstract