Impact of health insurance for the poor (ASKESKIN) on health services utilization in Indonesia

Abstract

Health insurance for the poor (ASKESKIN) is insurance program to protect the poor. ASKESKIN provides free services mainly in public health facilities, based on the referral system ranging from outpatient care in the community health center to tertiary health care services for inpatients in the district hospital. The main purpose of this program is to increase health utilization and quality of care among the poor in Indonesia. The aims of this study are to investigate the distribution of ASKESKIN program among the poor, its effect on the health service utilization and the pattern of health care choice. Data in this study was obtained from Indonesia’s Socio Economic Survey (SUSENAS) Health and Housing Module 2004 and 2007. However, the samples used in the study include only persons aged 19-60 years in the lowest income quintile to represent the poor. Besides the descriptive analysis for the ASKESKIN distribution, the logistic regression, and the OLS regression model are used to analyze the effect of ASKESKIN on health care utilization. The multinomial logit model is used to study the pattern of health care choice under ASKESKIN scheme. In addition to ASKESKIN enrollment variable, this study also includes other variables that determine health service utilization among the poor i.e. age, sex, marital status, self reported illness, day with illness, years of schooling, family size, location, income, year of insurance, health worker ratio, health facility ratio, distance and time to the nearest health facilities. The results of the study show that distribution of ASKESKIN program has mostly benefited the poor although there is some leakage to the non poor. ASKESKIN has affected overall outpatient utilization, overall inpatient utilization, public outpatient, public inpatient, and private inpatient utilization. Nevertheless, the ASKESKIN program seems to be insignificantly to private outpatient utilization. ASKESKIN program has the positive effect on the pattern of health care choice. It means that people under ASKESKIN program are more likely to choose public health facility rather than traditional healers or self treatment. Policy recommendations for improving the ASKESKIN program are as follows: (1) improving the distribution of ASKESKIN enrollees to avoid the leakage of the program to the non poor; and (2) for the increase in health care utilization, the government should improve the health care referral system to reduce the cost.