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Int. J. Environ. Res. Public Health 2013, 10(7), 2995-3013; doi:10.3390/ijerph10072995
Article

The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia: An Increase or a Decrease?

1,2,* , 1
,
1
 and
1
1 Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany 2 School of Public Health, Faculty of Medicine and Health Sciences, Jenderal Soedirman University, Kampus Karangwangkal, Purwokerto 53123, Indonesia
* Author to whom correspondence should be addressed.
Received: 30 April 2013 / Revised: 4 July 2013 / Accepted: 8 July 2013 / Published: 18 July 2013
(This article belongs to the Special Issue Health Economics)
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Abstract

We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.
Keywords: health insurance; out-of-pocket expenditures; panel data analysis health insurance; out-of-pocket expenditures; panel data analysis
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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Aji, B.; De Allegri, M.; Souares, A.; Sauerborn, R. The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia: An Increase or a Decrease? Int. J. Environ. Res. Public Health 2013, 10, 2995-3013.

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