Equity of health financing in Indonesia: A 5-year financing incidence analysis (2015–2019)

Cheng, Qinglu; Asante, Augustine; Susilo, Dwidjo; Satrya, Aryana; Man, Nicola; Fattah, Rifqi Abdul; Haemmerli, Manon; Kosen, Soewarta; Novitasari, Danty; Puteri, Gemala Chairunnisa; Adawiyah, Eviati; Hayen, Andrew; Gilson, Lucy; Mills, Anne; Tangcharoensathien, Viroj; Jan, Stephen; Thabrany, Hasbullah; Wiseman, Virginia

doi:10.1016/j.lanwpc.2022.100400

Cited by 12 publications

(17 citation statements)

References 27 publications

(32 reference statements)

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“…This must be acknowledged alongside the Scheme’s well-recognised and well- qualified achievements. 2,5…”

Section: Discussionmentioning

confidence: 99%

“…They can appear to perform well in financial protection while families carry on postponing treatment, a dissonance widely known yet often elided in middle and high income countries including Indonesia. 5,17 Many health systems assessments forego analysing foregone care. Had this been conducted, the picture of financial protection would have been altered.…”

Section: Discussionmentioning

confidence: 99%

“…Following Cheng and collaborators, I used the national social economic surveys, extended to fit a before-and-after design (2013 and 2021). 5,29 As secondary data the University of Manchester exempted the research from ethical review. The surveys collect spending using the United Nations’ Classification of Individual Consumption According to Purpose (COICOP).…”

Section: Methodsmentioning

confidence: 99%

“…28 The most recent assessment of the Scheme found that it had started with a progressive financial footing, but has subsequently been deteriorating to a point where finally in 2019 it turned regressive. 4,5 Ageing, however, has remained outside assessment. This work aims to bring it inside, specifically: to compare catastrophic health payment and financial impoverishment (summarised as financial hardship) just before the Scheme and after, 2013 and 2021, to compare the financial hardship experience of families with older members with other families (with younger members), in both years, to assess whether foregone care is masked in common measures of financial protection. This work contributes to the literature in explaining the specific challenges of ageing in rapidly ageing populations in the global south and to monitoring progress towards the goal of universal coverage.…”

Section: Introductionmentioning

confidence: 99%

“…Thanks to the Scheme, Indonesia has made notable progress in expanding health coverage and improving health outcomes. 2,4,5 But the Scheme faces many challenges including insufficient funding, low quality of care, inadequate human resources, and an ageing population. 4–7 These challenges pose risks to the sustainability and effectiveness of the Scheme to deliver financial protection.…”

Section: Introductionmentioning

confidence: 99%

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Fit for growing old? Financial protection before and after Indonesia’s national health insurance scheme – a repeated cross-section study

Tampubolon

2024

Preprint

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The world is ageing with unprecedented momentum, and large global south nations are ageing at higher speed than their northern peers. They have grown old while they have not grown rich, straining their health systems' ability to deliver financial protection. This work aimed to assess whether Indonesia's health insurance scheme, seven years on, has delivered equal protection for families with older members (over 60 years) as for other families. Methods Before-and-after observation study is designed to estimate how much difference the Scheme made to probabilities of catastrophic payment and financial impoverishment for the two family types. As in recent assessments, two national socioeconomic surveys were used (2013, 2021). Two level observations came from 622,125 families residing in 514 districts across the archipelago. Financial protection indicators against catastrophic payment and impoverishment were constructed following recent works. I estimated two level probit models, then plotted marginal probabilities of financial protection. A sensitivity analysis was conducted with the standard financial protection indicator. Findings After the Scheme, financial hardship for all family types has reduced by 19%. But families with older members (compared to other families) have an additional 0.7% risk of incurring catastrophic payment or financial impoverishment. And social and spatial inequalities in health persist. Discussion While the Scheme has markedly improved financial protection for all, families with older members remain at higher risk of being unprotected. The global south can prepare for an ageing world by monitoring financial protection and its social determinants and systematically distinguishing families with older members.

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“…This must be acknowledged alongside the Scheme’s well-recognised and well- qualified achievements. 2,5…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fit for growing old? Financial protection before and after Indonesia’s national health insurance scheme – a repeated cross-section study

Tampubolon

2024

Preprint

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How is the Societal Perspective Defined in Health Technology Assessment? Guidelines from Around the Globe

2022

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Some researchers have argued that the aim of an economic evaluation should be to offer guidance on resource allocation based on the interest of the public from a societal perspective. The application of a societal perspective in health technology assessment (HTA) while common in many published studies is not mandated in most countries, and there is limited discussion on what the societal perspective should encompass. This study aimed to systematically compare and contrast the HTA guidelines in different countries.HTA methods guidelines were identified through international HTA networks, such as ISPOR and GEAR. The respective HTA agencies were grouped into two categories: well-established and newly-developed, based on the establishment date. Data extracted from the guidelines summarised the methodological details in the reference cases, including specifics on the societal perspective. The database search yielded 46 guidelines, and 65% explicitly considered the societal perspective. The maturity of these agencies is reflected in their attitudes towards the societal perspective; the societal perspective is defined in 70% of the guidelines of well-established agencies and only 56% of those of newly-developed agencies. The guidelines from multi-payer healthcare systems are more likely to consider the societal perspective. Although most guidelines from the well-established agencies recommend the inclusion of a societal perspective, the types of costs and consequences that should be included and the recommended approaches to valuing them are variable. The direct costs to family and carers are included in 73% of the societal perspective definitions and non-health outcomes were considered in only 40%. Most HTA guidelines lack clear guidance on what to include under specific perspectives. Considering the recent advancements in economic evaluation methods, it is timely to re-think the role of the societal perspective in HTA guidelines and adopt a more comprehensive perspective to include all costs and consequences of healthcare services.

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Inequalities in women’s health insurance coverage before and after the implementation of universal health insurance in Indonesia

Rahmawati,

Hsieh,

Liang

2024

J Public Health Pol

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Equity of health financing in Indonesia: A 5-year financing incidence analysis (2015–2019)

Cited by 12 publications

References 27 publications

Fit for growing old? Financial protection before and after Indonesia’s national health insurance scheme – a repeated cross-section study

Fit for growing old? Financial protection before and after Indonesia’s national health insurance scheme – a repeated cross-section study

How is the Societal Perspective Defined in Health Technology Assessment? Guidelines from Around the Globe

Inequalities in women’s health insurance coverage before and after the implementation of universal health insurance in Indonesia

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