Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019

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dc.contributor.authorFattah, Rifqi A.
dc.contributor.authorCheng, Qinglu
dc.contributor.authorThabrany, Hasbullah
dc.contributor.authorSusilo, Dwidjo
dc.contributor.authorSatrya, Aryana
dc.contributor.authorHaemmerli, Manon
dc.contributor.authorKosen, Soewarta
dc.contributor.authorNovitasari, Danty
dc.contributor.authorPuteri, Gemala C.
dc.contributor.authorAdawiyah, Eviati
dc.contributor.authorHayen, Andrew
dc.contributor.authorGilson, Lucy
dc.contributor.authorMills, Anne
dc.contributor.authorTangcharoensathien, Viroj
dc.contributor.authorJan, Stephen
dc.contributor.authorAsante, Augustine
dc.contributor.authorWiseman, Virginia
dc.date.accessioned2023-09-19T08:14:48Z
dc.date.available2023-09-19T08:14:48Z
dc.date.issued2023-09-06
dc.date.updated2023-09-10T03:09:56Z
dc.description.abstractBackground Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. Methods This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. Results The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. Conclusions This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
dc.identifier.apacitationFattah, Rifqi A., Cheng, Q., Thabrany, H., Susilo, D., Satrya, A., Haemmerli, M., ... Wiseman, V. (2023). Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019. <i>International Journal for Equity in Health</i>, 22(1), 185. http://hdl.handle.net/11427/38750en_ZA
dc.identifier.chicagocitationFattah, Rifqi A., Qinglu Cheng, Hasbullah Thabrany, Dwidjo Susilo, Aryana Satrya, Manon Haemmerli, Soewarta Kosen, et al "Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019." <i>International Journal for Equity in Health</i> 22, 1. (2023): 185. http://hdl.handle.net/11427/38750en_ZA
dc.identifier.citationFattah, Rifqi A., Cheng, Q., Thabrany, H., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S. & Novitasari, D. et al. 2023. Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019. <i>International Journal for Equity in Health.</i> 22(1):185. http://hdl.handle.net/11427/38750en_ZA
dc.identifier.risTY - Journal Article AU - Fattah, Rifqi A. AU - Cheng, Qinglu AU - Thabrany, Hasbullah AU - Susilo, Dwidjo AU - Satrya, Aryana AU - Haemmerli, Manon AU - Kosen, Soewarta AU - Novitasari, Danty AU - Puteri, Gemala C. AU - Adawiyah, Eviati AU - Hayen, Andrew AU - Gilson, Lucy AU - Mills, Anne AU - Tangcharoensathien, Viroj AU - Jan, Stephen AU - Asante, Augustine AU - Wiseman, Virginia AB - Abstract Background Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. Methods This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. Results The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. Conclusions This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line. DA - 2023-09-06 DB - OpenUCT DP - University of Cape Town KW - Catastrophic health spending KW - Indonesia KW - Jaminan Kesehatan Nasional KW - Out-of-pocket payment LK - https://open.uct.ac.za PY - 2023 T1 - Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019 TI - Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019 UR - http://hdl.handle.net/11427/38750 ER -en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12939-023-01980-w
dc.identifier.urihttp://hdl.handle.net/11427/38750
dc.identifier.vancouvercitationFattah Rifqi A, Cheng Q, Thabrany H, Susilo D, Satrya A, Haemmerli M, et al. Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019. International Journal for Equity in Health. 2023;22(1):185. http://hdl.handle.net/11427/38750.en_ZA
dc.language.rfc3066en
dc.publisherBioMed Central
dc.publisher.departmentHealth Policy and Systems
dc.publisher.facultyHealth Sciences
dc.rights.holderBioMed Central Ltd., part of Springer Nature
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceInternational Journal for Equity in Health
dc.source.journalissue1
dc.source.journalvolume22
dc.source.pagination185
dc.source.urihttps://equityhealthj.biomedcentral.com/
dc.subjectCatastrophic health spending
dc.subjectIndonesia
dc.subjectJaminan Kesehatan Nasional
dc.subjectOut-of-pocket payment
dc.titleIncidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019
dc.typeJournal Article
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