Journal Article

An evaluation of health systems equity in Indonesia: study protocol

Gilson, Lucy, Mills, Anne, Patcharanarumol, Walaiporn, Haemmerli, Manon, Kosen, Soewarta, Thabrany, Hasbullah, Wiseman, Virginia, Hayen, Andrew, Tangcharoensathien, Viroj, Asante, Augustine

2018

Overview

Background Many low and middle income countries are implementing reforms to support Universal Health Coverage (UHC). Perhaps one of the most ambitious examples of this is Indonesia’s national health scheme known as the JKN which is designed to make health care available to its entire population of 255 million by end of 2019. If successful, the JKN will be the biggest single payer system in the world. While Indonesia has made steady progress, around a third of its population remains without cover and out of pocket payments for health are widespread even among JKN members. To help close these gaps, especially among the poor, the Indonesian government is currently implementing a set of UHC policy reforms that include the integration of remaining government insurance schemes into the JKN, expansion of provider networks, restructuring of provider payments systems, accreditation of all contracted health facilities and a range of demand side initiatives to increase insurance uptake, especially in the informal sector. This study evaluates the equity impact of this latest set of UHC reforms. Methods Using a before and after design, we will evaluate the combined effects of the national UHC reforms at baseline (early 2018) and target of JKN full implementation (end 2019) on: progressivity of the health care financing system; pro-poorness of the health care delivery system; levels of catastrophic and impoverishing health expenditure; and self-reported health outcomes. In-depth interviews with stakeholders to document the context and the process of implementing these reforms, will also be undertaken. Discussion As countries like Indonesia focus on increasing coverage, it is critically important to ensure that the poor and vulnerable - who are often the most difficult to reach – are not excluded. The results of this study will not only help track Indonesia’s progress to universalism but also reveal what the UHC-reforms mean to the poor.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Ambition / Benefit incidence / Catastrophic health spending / Certification / Clinical outcomes / Economic aspects / Equality and Human Rights / Equity / Expenditures / Financing / Financing incidence / GNI / Government / Gross National Income / Health care / Health care costs / Health care delivery / Health care expenditures / Health care facilities / Health care industry / Health care policy / Health care reform / Health Equity - economics / Health Equity - trends / Health Expenditures - trends / Health initiatives / Health insurance / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Research / Health status / Healthcare Financing / Humans / Indonesia / Inequality / Informal economy / Insurance / Insurance coverage / Low income groups / Medicine / Medicine & Public Health / National health insurance / Payments / Planning / Public Health / Qualitative research / Quality / Reforms / Social Justice / Social Policy / Studies / Study Protocol / Systems analysis / Universal health coverage / Universal Health Insurance - economics / Universal Health Insurance - trends / Universalism / Uptake