Impact Evaluation Indonesia’s National Health Insurance: Strengthening and Equalization Health Services

Abstraksi

Indonesia just launched National Health Insurance (NHI) since 2014 that forced all people of Indonesia involved in this program. The background of this program referred to Indonesia’s constitution in article 25 section 1 said that everyone has the right to a proper environment for his health and well-being and family including the right to food, clothing, housing, and health care and social services needed and the right to be unemployed, sick, disabled, widowed, reaching people who make a living, which is beyond his power. In addition, the 58th session in 2005 in Jenewa, World Health Assembly (WHA) agreed to develop universal health coverage to provide health access to people. Moreover, Indonesia’s ideology in Pancasila in fifth (5th) said that social justice for all the people of Indonesia. It means that all people of Indonesia have the same right to get access to health, education, and national resources. Therefore, the government of Indonesia launched national health insurance to make sure that all the people of Indonesia get the same access to health care. Nowadays, since NHI was launched in 2014 that all people of Indonesia whether civil servants, entrepreneurs, private employees, and self-employees must join in NHI. Then, all people in Indonesia who are registered as a member of NHI can access health services across countries. The scope has been enlarged from local to national. As a result, all the people of Indonesia must be a member of NHI that is managed by a health social insurance administration organization (HSIAO/BPJS Kesehatan). However, they can also have more health insurance from a private insurance company. The concept of the program is cross-subsidy that means the people who need health treatment get the subsidy from the people who do not need health treatment. Even though NHI is an excellent national health insurance system, there are many problems involved in this program. First, health care access is not equal to each region or province. The people who live in regions/provinces have good health facilities will get more benefits than people live in regions/provinces which have not good facilities. Second, nowadays, HSIAO budget is a deficit because the amount of money for health claims are much more than the amount of money from a mandatory fee. Third, HSIAO will cover almost all diseases, even though the claims are restricted by Indonesia Case Base Groups (Ina-CBGs). Ina-CBGs is a package payment system that was created by the Ministry of Health based on the patient’s diseases survey. The guidance is used to HSIAO to give any treatment to all patients. This research is very important because since 2014 NHI faced many problems from HSIAO’s patient neglected to the fiscal deficit problem. Patients neglected due to inequality conditions of health facilities between cities and villages. On the other hand, financial deficits happened to HSIAO because the number of money claims is more than the number of mandatory fees. In 2016, the HSIAO recorded financial deficit around Rp6.23 Trillion. In 2017, the deficit was increasing around Rp16.5 trillion. Furthermore, the government needs to evaluate the NHI program that has been conducted by HSIAO. The evaluation must be conducted to know what does the impact of the NHI program to people welfare. What is kind of benefit from the NHI program to people welfare? How people get benefit from the NHI program? What should the government do to make sure that NHI can be sustainable as universal health coverage? The sustainable of NHI program is important to give access to health care services for all citizen of Indonesia. This research uses an econometric model which are ordinary least square (OLS) and difference-in-differences (DiD) with STATA program. The DiD is a fit model because it can capture the impact of the NHI program. This research will use some data sets which are IFLS that data is used by two times period. The first period captured that condition was with and without the program, and the second period captured that the program has been implemented with individual treatment and control also. The data sets are divided into two groups which are the control group and treatment group. The DiD estimator will capture changed of a benefit of the program. The discrepancy between two conditions is called an impact of the program. The DiD estimator has an assumption that both groups are identical groups. The similarities of both groups are economic conditions, geography, and situations. This research will measure the impact of the program that uses ordinary least square (OLS) and difference-in-differences (DiD), and the researcher assumes that result of the estimation is robust, and the assumption of the residual is best linear unbiased estimator (BLUE). The result shows that national health insurance (NHI) gives equally an opportunity for Indonesian citizen to access health care services. Moreover, it will increase people welfare because they can access affordable health care services. The poor people will get a higher benefit for this program, however, people who live in a city and live close to the health care center will get more benefit. Transportation and accommodation costs are also making people consider access to health care services, especially for poor people and who live in far away from the health care center. Even though, the program aggregately increases people welfare by accessing affordable health care center. Then, the sustainability of the program is still uncertain because HSIAO/BPJS Kesehatan facing a deficit and potentially getting bigger in the future. It is important and necessary to be concerned for the government. The increasing health status is also a way to improve human capital. Moreover, Indonesian vision is to be a developed country and one of the requirement is high productivity. It can be achieved only by improving access and quality of health services and education. Therefore, the sustainability of national health insurance is needed to be strongly struggled for government by refinement the program and increasing the mandatory fee, without reducing the benefit of the program.