Rizal Muhammad Fikru
Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada Yogyakarta, Daerah Istimewa Yogyakarta, Indonesia.
Health Econ. 2025 Mar;34(3):500-517. doi: 10.1002/hec.4922. Epub 2024 Dec 11.
This paper investigates the impact of a dependent coverage age-eligibility rule on young adults' health and healthcare utilisation under Indonesia's National Health Insurance (NHI) program. Employing a regression discontinuity design, analysis of the NHI administrative data documents a significant 14.6 to 20.9 percentage points drop in coverage among young adults at age 21, the age cut-off imposed by the rule. Using a large nationally representative household survey, this paper shows that the loss of insurance coverage does not change young adults' health status but markedly decreases the utilisation of outpatient care among those who are ill. Specifically, there is an abrupt 5.3 to 8.4 percentage points reduction in the probability of young adults having any outpatient visit in the past month, primarily driven by lower utilisation of primary care services. The study also finds an increased likelihood of self-treatment and the use of traditional healers, indicating a substitution effect. Further analysis shows a larger impact on those who are poor, less educated, and live in regions with higher healthcare costs.
本文研究了印度尼西亚国家医疗保险（NHI）计划中受抚养人覆盖年龄资格规则对年轻人健康和医疗保健利用的影响。采用回归断点设计，对NHI行政数据的分析表明，在21岁（该规则规定的年龄界限）的年轻人中，保险覆盖率显著下降了14.6至20.9个百分点。利用一项具有全国代表性的大型家庭调查，本文表明，保险覆盖范围的丧失并未改变年轻人的健康状况，但显著降低了患病者的门诊医疗利用率。具体而言，过去一个月内年轻人进行任何门诊就诊的概率突然下降了5.3至8.4个百分点，主要原因是初级保健服务的利用率降低。该研究还发现自我治疗和使用传统治疗师的可能性增加，表明存在替代效应。进一步分析表明，对贫困、受教育程度较低以及生活在医疗成本较高地区的人群影响更大。
