TY - JOUR
T1 - Incidence of catastrophic health spending in Indonesia
T2 - insights from a Household Panel Study 2018–2019
AU - Fattah, Rifqi Abdul
AU - Cheng, Qinglu
AU - Thabrany, Hasbullah
AU - Susilo, Dwidjo
AU - Satrya, Aryana
AU - Haemmerli, Manon
AU - Kosen, Soewarta
AU - Novitasari, Danty
AU - Puteri, Gemala Chairunnisa
AU - Adawiyah, Eviati
AU - Hayen, Andrew
AU - Gilson, Lucy
AU - Mills, Anne
AU - Tangcharoensathien, Viroj
AU - Jan, Stephen
AU - Asante, Augustine
AU - Wiseman, Virginia
N1 - Funding Information:
The ENHANCE Study (Equity and Health Care Financing in Indonesia) was supported through the Health Systems Research Initiative in the UK, and is jointly funded by the Department of International Development, the Economic and Social Research Council, the Medical Research Council and the Wellcome Trust. The funders of this research were not involved in the study. The research would not have been possible without the time and support of all the families and field workers that took part in our household surveys, to them we are very grateful.
Funding Information:
This study is supported by a grant from the Health Systems Research Initiative in the UK, jointly funded by the Department of International Development, the Economic and Social Research Council, the Medical Research Council and the Wellcome Trust (MR/P013996/1).
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. Methods: This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. Results: The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. Conclusions: This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
AB - Background: Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. Methods: This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. Results: The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. Conclusions: This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
KW - Catastrophic health spending
KW - Indonesia
KW - Jaminan Kesehatan Nasional
KW - Out-of-pocket payment
UR - http://www.scopus.com/inward/record.url?scp=85169977392&partnerID=8YFLogxK
U2 - 10.1186/s12939-023-01980-w
DO - 10.1186/s12939-023-01980-w
M3 - Article
C2 - 37674199
AN - SCOPUS:85169977392
SN - 1475-9276
VL - 22
JO - International Journal for Equity in Health
JF - International Journal for Equity in Health
IS - 1
M1 - 185
ER -
