Inequality in access to health care, health insurance and the role of supply factors

Johar, M; Soewondo, P; Pujisubekti, R; Satrio, HK; Adji, A

Inequality in access to health care, health insurance and the role of supply factors

Johar, M

Soewondo, P Pujisubekti, R Satrio, HK Adji, A

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Publication Type:: Journal Article
Citation:: Social Science and Medicine, 2018, 213 pp. 134 - 145
Issue Date:: 2018-09-01

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Field	Value	Language
dc.contributor.author	Johar, M https://orcid.org/0000-0002-2381-1741	en_US
dc.contributor.author	Soewondo, P	en_US
dc.contributor.author	Pujisubekti, R	en_US
dc.contributor.author	Satrio, HK	en_US
dc.contributor.author	Adji, A	en_US
dc.date.available	2018-07-25	en_US
dc.date.issued	2018-09-01	en_US
dc.identifier.citation	Social Science and Medicine, 2018, 213 pp. 134 - 145	en_US
dc.identifier.issn	0277-9536	en_US
dc.identifier.uri	http://hdl.handle.net/10453/130316
dc.description.abstract	© 2018 Elsevier Ltd While disparities in access to health services by different economic groups have been well documented, much less is known about the factors that are contributing to these disparities. In this paper, we take the case of Indonesia, which has the six-worst wealth inequality in the world. The data is derived from the national socio-economic survey from 2011 to 2016, giving a total sample of over 5.5 million individuals. We find that only access to outpatient care at public primary health facilities is pro-poor, whilst access to other types of health care is pro-rich. Decomposition analysis demonstrates that the pro-rich access is driven by households’ economic conditions, geographical variations, and supply-side factors that tend to disfavour the poor. Exploiting a nation-wide health insurance expansion during the study period, we go beyond most studies to examine how inequality in access and the contributions of these determinants may have changed under the new regime. We find that access gaps have narrowed, driven by a weaker association between access and households’ economic status. Urban areas see a bigger reduction. Access to health services is generally greater, supported by increased participation of private providers under the new regime. However, we have yet to see a bigger reduction in the access gap due to more equal distribution of health infrastructure. Policies that may foster economic growth and increase households’ economy, as well as health taskforce reallocation to reach greater number of poor and/or rural patients may reduce the inequality in access to health services further.	en_US
dc.relation.ispartof	Social Science and Medicine	en_US
dc.relation.isbasedon	10.1016/j.socscimed.2018.07.044	en_US
dc.subject.classification	Public Health	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Cross-Sectional Studies	en_US
dc.subject.mesh	Socioeconomic Factors	en_US
dc.subject.mesh	Rural Population	en_US
dc.subject.mesh	Health Services	en_US
dc.subject.mesh	National Health Programs	en_US
dc.subject.mesh	Indonesia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Healthcare Disparities	en_US
dc.title	Inequality in access to health care, health insurance and the role of supply factors	en_US
dc.type	Journal Article
utslib.citation.volume	213	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
utslib.for	16 Studies in Human Society	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
utslib.copyright.status	closed_access
pubs.publication-status	Published	en_US
pubs.volume	213	en_US

Abstract:

© 2018 Elsevier Ltd While disparities in access to health services by different economic groups have been well documented, much less is known about the factors that are contributing to these disparities. In this paper, we take the case of Indonesia, which has the six-worst wealth inequality in the world. The data is derived from the national socio-economic survey from 2011 to 2016, giving a total sample of over 5.5 million individuals. We find that only access to outpatient care at public primary health facilities is pro-poor, whilst access to other types of health care is pro-rich. Decomposition analysis demonstrates that the pro-rich access is driven by households’ economic conditions, geographical variations, and supply-side factors that tend to disfavour the poor. Exploiting a nation-wide health insurance expansion during the study period, we go beyond most studies to examine how inequality in access and the contributions of these determinants may have changed under the new regime. We find that access gaps have narrowed, driven by a weaker association between access and households’ economic status. Urban areas see a bigger reduction. Access to health services is generally greater, supported by increased participation of private providers under the new regime. However, we have yet to see a bigger reduction in the access gap due to more equal distribution of health infrastructure. Policies that may foster economic growth and increase households’ economy, as well as health taskforce reallocation to reach greater number of poor and/or rural patients may reduce the inequality in access to health services further.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/130316