Immpact and HERU, University of Aberdeen, UK.
Health Policy Plan. 2010 May;25(3):237-47. doi: 10.1093/heapol/czp060. Epub 2009 Dec 8.
The Indonesian Government recently introduced a health insurance scheme to improve access to care for the poor. We investigated the payments made by households for different types of obstetric care, the economic consequences of payments and the effects of the new insurance on that expenditure.
Expenditures on obstetric care for women were collected from three main hospitals in the Serang and Pandeglang districts of Banten Province for all 'near-miss' cases (372), a sample of normal deliveries (146) and deliveries with Caesarean section (98) over a 6-month period. Women were also interviewed after they were discharged to collect information on economic status, household expenditure and source of payment for care.
Average expenditure by the mothers for near-miss cases was found to be Rp 2.6m (US$279) and Rp 1.9m (US$205) in Serang and Pandeglang Hospitals, respectively. Caesarean section was found to be the most expensive intervention. Insurance for the poor covered 51% of women at Serang Hospital and 73% of women at Pandeglang. Around 68% of households in the poorest quintiles would have made catastrophic payments. Insurance for the poor appears to have some positive association with the hospitals' expenditure for treatment of different types of maternal care.
Insurance for the poor appeared to be relatively effective in protecting households from catastrophic payments. However, it is not sufficient only to cover the very poor; the non-poor can also suffer catastrophic payments and they are only protected because hospital rules over who qualifies have been relaxed. Although the association between insurance and expenditure for obstetric care was important, it was not clear that this represents over-provision of services but rather that it reflected previously inadequate treatment given to those unable to pay.
印度尼西亚政府最近推出了一项医疗保险计划，以改善贫困人口获得医疗服务的机会。我们调查了家庭在不同类型的产科护理方面的支付情况、支付的经济后果，以及新保险对这种支出的影响。
在万丹省塞尔朗和潘当格朗区的三家主要医院，对所有“接近病例”（372 例）、正常分娩（146 例）和剖宫产（98 例）样本进行了为期 6 个月的产科护理费用收集。在妇女出院后，还对她们进行了访谈，以收集有关经济状况、家庭支出和护理支付来源的信息。
塞尔朗医院和潘当格朗医院接近病例的母亲平均支出分别为 260 万印尼盾（279 美元）和 190 万印尼盾（205 美元）。剖宫产是最昂贵的干预措施。贫困保险覆盖了塞尔朗医院 51%的妇女和潘当格朗医院 73%的妇女。最贫困的五分之一家庭中约有 68%会有灾难性的支出。贫困保险似乎与医院治疗不同类型的孕产妇护理的支出有一定的正相关关系。
贫困保险似乎在保护家庭免受灾难性支出方面相对有效。然而，仅仅覆盖最贫困人口是不够的；非贫困人口也可能遭受灾难性支出，他们只是因为医院放宽了谁有资格获得保险的规定而得到了保护。尽管保险和产科护理支出之间的关联很重要，但尚不清楚这是否代表服务过度提供，而只是反映了以前对无法支付费用的人给予的治疗不足。
