Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany.
Int J Environ Res Public Health. 2013 Jul 18;10(7):2995-3013. doi: 10.3390/ijerph10072995.
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.
我们利用印度尼西亚家庭生活调查的面板数据，研究了医疗保险计划对减少自付支出的影响。我们采用了三种线性面板数据模型，其中两种考虑了内生性：混合普通最小二乘法（OLS）、工具变量（IV）的两阶段最小二乘法（2SLS）和固定效应（FE）。研究结果表明，两种医疗保险计划通过使用 IV 估计对自付支出产生了显著的负向影响。在 IV 模型中，与非 Askeskin 和非 Askes 相比，Askeskin 分别降低了 34%和 55%的自付支出，而 Jamsostek 对自付支出的影响不显著。在 FE 模型中，只有 Askeskin 对自付支出产生了显著的负向影响，降低了 11%的自付支出。本研究表明，印度尼西亚现有的两个大型医疗保险计划 Askeskin 和 Askes 有效地降低了家庭自付支出。这些计划通过降低自付支出提供财务保障的能力，可能是其福利计划和共付政策的直接函数。
