Hidayat Budi, Thabrany Hasbullah, Dong Hengjin, Sauerborn Rainer
Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany.
Health Policy Plan. 2004 Sep;19(5):322-35. doi: 10.1093/heapol/czh037.
This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.
本文考察了强制医疗保险对印度尼西亚公立和私立门诊医疗服务的可及性及可及性公平性的影响。研究使用了1997年印度尼西亚家庭生活调查第二轮的数据。我们采用集中指数作为公平性的衡量指标，该指数根据实际数据以及从多项逻辑回归中得出的门诊医疗服务使用预测概率来计算。研究发现，公务员强制保险计划（Askes）对公立门诊医疗服务的可及性有强烈的积极影响，而私营企业员工强制保险计划（Jamsostek）对公立和私立门诊医疗服务的可及性均有积极影响。在贫困受益人中观察到Jamsostek的影响最大。将保险覆盖范围扩大到全体人口将大幅提高医疗服务的可及性。然而，Askes和Jamsostek对公平性均未产生积极影响。文中还讨论了政策含义。
