印尼衛生照護之不均等：長期追蹤調查之實證結果

Inequity of Access to Healthcare in Indonesia:Longitudinal Survey Evidence

Herman Sumawan(Herman Sumawan)

指導教授 ： 張明正

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

Objective : (1)To study the determinants of health service utilization as outpatient care and hospitalization in Indonesia from socioeconomic perspective before and after economic crisis (2) To analyze causal effect of the socioeconomic determinants to outpatient care and hospitalization in Indonesia (3) To examine the inequality
distribution health services utilization among income level (4) To estimate the horizontal inequity of access to health care in Indonesia between years 1993 - 2000.
Methods: This study conducted using panel data from Indonesia Family Life survey in 1993, 1997, and 2000. The analysis will carry out in to two parts: panel and cross sectional analysis. The total response rate can be analyzed in this study is 83.3 % ( N= 9325) for the panel. Cross sectional data only using year 1997 and 2000, with number of sample 18162 and 23521, respectively. The study focuses on two type’s utilization of health services: outpatient and inpatient care. Anderson’s behavioral model of health services utilization provides the framework for analysis. Statistic analysis for this study is logistic regression which used separately at each time point of time, and two part models (Probit and Newey Regression) used to measure concentration index and horizontal inequity.
Main Finding: Analytical result suggest that horizontal inequity and inequality among income groups exist in Indonesia are favoring the better off (rich people), where hospitalization has higher inequality than outpatient. Situation after economic crisis exhibit the inequality for hospitalization is getting worse than previous year,
while outpatient care is better than in 1993 but lower than in 1997. In term of predictor utilization, the predisposing factors: female, married, higher education are determinant of both of type utilization, while age did not show any association except for age 65 and above. Among enabling factor, income and having health insurance play major role in affecting hospitalization and outpatient care, and more prominent after economic crisis. Two needs variables showed the self perceived and ADL are strong determinants for hospitalization, while morbidity more prominent in outpatients compares two other needs. Health system factor such as travel time and travel cost in certain circumstances has relationship with the utilization.
Conclusion and Recommendation: The study gave indications as regards socioeconomic differences in access to health care especially for the low income. The inequality on utilization is favoring to better off while inpatient care has big index inequality due to decreasing ability to pay after economic crisis. The results urge for government intervention to reduce the burden of the poor and to give protection on access to health care from delivery aspect and financing. A combination of developing risk-sharing schemes; allocation public resources spread more evenly; government subsidized health insurance for poor people; and in the long-run, universal coverage of health insurance. Expanding services in the community health centre, cooperation between public health centre and public hospital, increasing mobile health services, and allocation of health resources more evenly should be considered in health policies.

關鍵字

Equity ； Equality ； Access to healthcare ； Health Services Utilization ； Socioeconomic inequality to healthcare utilization ； Panel data ； IFLS ； Indonesia

並列摘要

Objective : (1)To study the determinants of health service utilization as outpatient care and hospitalization in Indonesia from socioeconomic perspective before and after economic crisis (2) To analyze causal effect of the socioeconomic determinants to outpatient care and hospitalization in Indonesia (3) To examine the inequality
distribution health services utilization among income level (4) To estimate the horizontal inequity of access to health care in Indonesia between years 1993 - 2000.
Methods: This study conducted using panel data from Indonesia Family Life survey in 1993, 1997, and 2000. The analysis will carry out in to two parts: panel and cross sectional analysis. The total response rate can be analyzed in this study is 83.3 % ( N= 9325) for the panel. Cross sectional data only using year 1997 and 2000, with number of sample 18162 and 23521, respectively. The study focuses on two type’s utilization of health services: outpatient and inpatient care. Anderson’s behavioral model of health services utilization provides the framework for analysis. Statistic analysis for this study is logistic regression which used separately at each time point of time, and two part models (Probit and Newey Regression) used to measure concentration index and horizontal inequity.
Main Finding: Analytical result suggest that horizontal inequity and inequality among income groups exist in Indonesia are favoring the better off (rich people), where hospitalization has higher inequality than outpatient. Situation after economic crisis exhibit the inequality for hospitalization is getting worse than previous year,
while outpatient care is better than in 1993 but lower than in 1997. In term of predictor utilization, the predisposing factors: female, married, higher education are determinant of both of type utilization, while age did not show any association except for age 65 and above. Among enabling factor, income and having health insurance play major role in affecting hospitalization and outpatient care, and more prominent after economic crisis. Two needs variables showed the self perceived and ADL are strong determinants for hospitalization, while morbidity more prominent in outpatients compares two other needs. Health system factor such as travel time and travel cost in certain circumstances has relationship with the utilization.
Conclusion and Recommendation: The study gave indications as regards socioeconomic differences in access to health care especially for the low income. The inequality on utilization is favoring to better off while inpatient care has big index inequality due to decreasing ability to pay after economic crisis. The results urge for government intervention to reduce the burden of the poor and to give protection on access to health care from delivery aspect and financing. A combination of developing risk-sharing schemes; allocation public resources spread more evenly; government subsidized health insurance for poor people; and in the long-run, universal coverage of health insurance. Expanding services in the community health centre, cooperation between public health centre and public hospital, increasing mobile health services, and allocation of health resources more evenly should be considered in health policies.

並列關鍵字

Equity ； Equality ； Access to healthcare ； Health Services Utilization ； Socioeconomic inequality to healthcare utilization ； Panel data ； IFLS ； Indonesia

參考文獻

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