Department of Health Sciences, University of York, York, UK.
Int J Public Health. 2019 May;64(4):603-613. doi: 10.1007/s00038-019-01215-2. Epub 2019 Feb 8.
This study is the first rigorous evaluation of the impact of Jaminan Kesehatan Nasional (JKN) on improving access to outpatient and inpatient care, utilising longitudinal data from the Indonesian Family Life Survey.
Two treatment groups were identified: a contributory group (N = 982), who paid the premium voluntarily, and a subsidised group (N = 2503), paid by government. Each group was compared with the uninsured group (N = 8576). Propensity score matching combined with difference-in-difference approaches was used to estimate the causal effect of the JKN programme.
The results found that JKN increased the probability of inpatient admission for the contributory and subsidised groups by 8.2% (95% CI 5.9-10.5%) and 1.8% (95% CI 0.7-2.82%), respectively. The contributory group had an increase in probability of an outpatient visit of 7.9% (95% CI 4.3-11.4%).
The JKN programme has increased the utilisation of outpatient and inpatient care in the contributory group. Those with subsidised insurance have an increase in access to inpatient facilities only, and this is of a smaller magnitude. Hence, while JKN has improved average utilisation, inequity in access to both outpatient and inpatient care may remain.
本研究首次利用印度尼西亚家庭生活调查的纵向数据，严格评估全民健康保险（JKN）对改善门诊和住院服务可及性的影响。
确定了两个治疗组：缴费组（N=982），自愿缴纳保费；补贴组（N=2503），由政府支付。每组均与未参保组（N=8576）进行比较。采用倾向评分匹配与差分法相结合来估计 JKN 计划的因果效应。
结果发现，JKN 使缴费组和补贴组的住院入院概率分别增加了 8.2%（95%CI 5.9-10.5%）和 1.8%（95%CI 0.7-2.82%）。缴费组门诊就诊概率增加了 7.9%（95%CI 4.3-11.4%）。
JKN 计划增加了缴费组门诊和住院服务的利用率。享受补贴保险的人群仅增加了住院服务的可及性，而且程度较小。因此，虽然 JKN 提高了平均利用率，但门诊和住院服务可及性方面的不平等可能仍然存在。
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