Ira Yusnita Wijayati, Dwini Handayani

National Health Insurance on Household Out-of-pocket Health Expenses in Indonesia

Introduction

National health insurance on household out-of-pocket health expenses in indonesia. Analyze the impact of Indonesia's National Health Insurance (BPJS Kesehatan) on household out-of-pocket health expenses. Reveals a 26% increase, urging policy improvements for optimal usage.

Abstract

BPJS Kesehatan is expected to increase access to fair and high-quality health care for all citizens and provide financial risk protection. Our study aims to examine the impact of BPJS Kesehatan’s implementation as national health insurance (NHI) on household out-of-pocket expenses. Our study used a difference in differences (DID) regression model that was applied to repeated cross-section data from the National Socio-Economic Survey (Susenas) between 2013-2014 and 2019-2020. Propensity-score matching (PSM) is used to provide covariate balance in the regression model data. Illnesses that are represented by health conditions and treatment options (self-medication, outpatient, inpatient) are determining factors of out-of-pocket expenses. Our finding, the implementation of BPJS Kesehatan resulted in a 26.0% increase in out-of-pocket expenses. Its main reason is an increase in public health awareness, as indicated by the increased number of visits to health facilities. However, the increase in out-of-pocket expenses suggests that the usage of BPJS Kesehatan is not optimal. To optimize its function as financial protection, improvements must be made to the mechanism and system policies.

Review

This study addresses a critically important and timely topic concerning the impact of Indonesia's national health insurance, BPJS Kesehatan, on household out-of-pocket (OOP) health expenses. The authors employ a robust methodological approach, utilizing a Difference-in-Differences (DID) regression model applied to repeated cross-sectional data from the National Socio-Economic Survey (Susenas) spanning two key periods (2013-2014 and 2019-2020). The integration of Propensity-Score Matching (PSM) to ensure covariate balance further strengthens the internal validity of their analysis, allowing for a more credible estimation of the causal effect of BPJS Kesehatan. By also considering illness represented by health conditions and treatment options, the study attempts to control for key determinants of health spending. The central finding—a 26.0% increase in household OOP expenses following BPJS Kesehatan’s implementation—is both significant and counterintuitive to the primary goal of financial risk protection. The authors attribute this rise primarily to an increase in public health awareness, leading to a greater number of visits to health facilities. While this explanation is plausible, suggesting that increased access might lead to higher utilization, it also points to a potential gap in the insurance's protective function. The conclusion that "the usage of BPJS Kesehatan is not optimal" in providing financial protection warrants closer examination, as it implies that despite increased awareness and utilization, the system is not adequately buffering households from financial shocks. To further enhance the impact and clarity of this valuable research, future work could delve deeper into the specific components contributing to the 26% increase in OOP expenses. Understanding *what* categories of expenses (e.g., co-payments, non-covered services, informal payments, transportation, drugs) are driving this increase would offer more precise insights into the "suboptimal" aspects of BPJS Kesehatan's function. Additionally, exploring the mechanisms behind "non-optimal usage"—whether it pertains to benefit package design, administrative barriers, provider availability, or patient understanding of entitlements—would provide actionable policy recommendations. Disaggregating findings by socioeconomic strata or illness severity could also reveal differential impacts and help tailor policy improvements to those most vulnerable to increased health expenditures.

Full Text

Comments

You need to be logged in to post a comment.