Waters Hugh, Saadah Fadia, Pradhan Menno
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Health Policy Plan. 2003 Jun;18(2):172-81. doi: 10.1093/heapol/czg022.
This article identifies the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. The article places the findings in the context of a framework showing the complex cause and effect relationships underlying the effects of economic downturns on health and health care. The results are based on primary analysis of Indonesian household survey data and review of a wide range of sources from the Indonesian government and international organizations. Comparisons are drawn with the effects of the crisis in Thailand. The devaluation of the Indonesian currency, the Rupiah, led to inflation and reduced real public expenditures on health. Households' expenditures on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported morbidity increased sharply from 1997 to 1998 in both rural and urban areas of Indonesia. The crisis led to a substantial reduction in health service utilization during the same time period, as the proportion of household survey respondents reporting an illness or injury that sought care from a modern health care provider declined by 25%. In contrast to Indonesia, health care utilization in Thailand actually increased during the crisis, corresponding to expansion in health insurance coverage. The results suggest that social protection programmes play a critical role in protecting populations against the adverse effects of economic downturns on health and health care.
本文确定了1997 - 1998年东亚经济危机对印度尼西亚医疗保健利用和健康状况的影响。本文将研究结果置于一个框架背景下，该框架展示了经济衰退对健康和医疗保健产生影响背后复杂的因果关系。研究结果基于对印度尼西亚家庭调查数据的初步分析以及对来自印度尼西亚政府和国际组织的广泛资料来源的审查。同时还与泰国危机的影响进行了比较。印度尼西亚货币卢比贬值导致通货膨胀，并减少了实际公共卫生支出。家庭在医疗保健方面的支出也有所下降，无论是绝对支出还是占总支出的百分比。1997年至1998年期间，印度尼西亚农村和城市地区自我报告的发病率均大幅上升。同期，危机导致医疗服务利用率大幅下降，因为在家庭调查受访者中，报告生病或受伤并寻求现代医疗服务提供者治疗的比例下降了25%。与印度尼西亚不同，泰国在危机期间医疗保健利用率实际上有所上升，这与医疗保险覆盖范围的扩大相对应。研究结果表明，社会保护方案在保护民众免受经济衰退对健康和医疗保健的不利影响方面发挥着关键作用。
