JUSTICE IN MODERN HEALTH CARE PERSPECTIVES FOR THE 21 ST CENTURY

Abstract

Mandatory health insurance with the largest coverage of insured in Indonesia tends to have a potential effect on decreasing equality gap of health care expenditures among regions in Indonesia. This study tried to investigate the equality gap by measuring health care expenditures and the effect of mandatory health insurance in decreasing its inequality among regions in Indonesia. A secondary analysis research study design was employed using panel data from three waves of Indonesian Family Life Survey (IFLS) year 1993, 1997 and 2000. Out-of-pocket payments (OOP) were used as indicator of health care expenditures with household as unit of analysis. To evaluate inequality for different regions, we used mean differences of OOP payments among regions. Furthermore, to assess the effects of mandatory health insurance on decreasing household OOP medical expenditures among regions, we used linear regression with natural log transformation. The study results showed that inequality of OOP payments still exist and prevail among different regions. In addition, mandatory health insurance was unable to decrease inequality of health care expenditures among different regions in Indonesia. Unequal distribution of health care resources, health seeking behavior differences and regional income level differences posed as major causes of inequality. Scaling up of health insurance beneficiary coverage will serve as thrust to disentangle these problems. Strategies towards achieving equal distribution of health facilities and health human resources stand a further requirement for increasing access to health services.