Study on Health Insurance Benefit Package Based on Community Preference

Presenter: Ali Ghufron Mukti, University of Gadjah Mada

Abstract

Background: The Indonesian government is committed to Social Health Insurance to guarantee access and quality health care for the majority of the people. Consequently, the social health insurance program in Indonesia was enacted in 2004 as a centralistic insurance program administered by government agencies at the national level. It has two systems, first that was developed for those who are able to pay and secondly the system for those who cannot afford the contribution.

Unfortunately, the health sector was faced a severe financial deficit due to increasing health expenditure. Therefore, designing a new benefit package is crucial. To overcome the financial deficit a study on assessment of benefit package based on Community Preference on different fiiscal capacity was conducted.

Methodology: A descriptive study using a cross sectional design was applied. The data presented in the study was collected from DKI Jakarta, East Nusa Tenggara and South Sulawesi provinces as representative of three different fiscal capacity with a proportional size random sampling of total 1300 respondents were selected. Data was collected using various catalogues of benefit package were provided to be chosen by selected respondents to assess community preference. In addition data were collected using interviews, participant observation, and focus group discussion to enrich the finding.

Result: It was found that the community’s preference varies between the fiscal status. In the defined catalogue of benefit package, positive value of conjoint analysis shown that respondents prefer to choose the limitation of disease and drug inclusions of services. For the type of provider, 46.1 % respondents more likely to access government facility for primary health care and 37.9 % preferred private provider. At high fiscal province, 40.7 % respondents shown to choose private hospital for referral case, more than those who prefer government facility listed by the Health Insurance carrier around 2.1 %. And 38.6 % were more likely to have a free choices. Positive value for conjoint analysis result shown that transportation cost was an important issue for the community lives in low fiscal area due to geographical problem to reach health facilities.

Conclusion: The result of study shown that in designing benefit package based on community preference, there were factors should be taking into account. They were the limitation of disease and drug covered by the scheme, transportation cost, choices of primary health care and hospital as health care provider. Community preference varies between different area of fiscal capacity.