Social health insurance for the poor: targeting and impact of Indonesia's Askeskin programme

Abstract

A first step towards meeting Indonesia's ambition for universal health insurance was made in 2005 with the introduction of the Askeskin programme, a subsidized social health insurance targeted to the informal sector and the poor. This paper investigates targeting and impact of the Askeskin programme using panel data for 8582 households observed in 2005 and 2006, and applying difference-in-differences estimation in combination with propensity score matching. We find that the programme is indeed targeted to the poor and those most vulnerable to catastrophic out-of-pocket health payments. Social health insurance improves access to health care in that it increases utilization of outpatient among the poor, while out-of-pocket spending seems to have increased for Askeskin insured in urban areas.

Keywords: Health care utilization; Impact evaluation; Indonesia; Out-of-pocket health payments; Social health insurance.