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Protecting poor pregnant mothers and newborns in the era of universal health care scheme: case of Indonesia

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Protecting Poor Pregnant Mothers and Newborns in the Era of Universal Healthcare Scheme: Case of Indonesia

 Authors: Athia Yumna, Sri Budiyati, Asep Kurniawan, Nurmala Selly Saputri, Yudi Fajar, Kartawijaya (The SMERU Research Institute, Jakarta INDONESIA)

Background:

Financial barrier is one of the main constraints for the Indonesian poor to access the maternal, newborn, and child health (MNCH) services. In its new universal healthcare scheme, known as Jaminan Kesehatan Nasional (JKN) which was launched on 1 January this year, the government provides insurance coverage for the poor in the beneficiary list. It is expected that through this scheme, the poor will have financial protection from out-of-pocket (OOP) health expenditures at a healthcare facility.

Methods:

Employing mainly qualitative approach, which is supported by quantitative data at national and kabupaten/kota (district) levels, this study investigates how JKN covers the worst-off women and children to access the MNCH services in seven selected kabupaten/kota.

Findings:

From this study we found that, while JKN indeed protects the insured, poor pregnant mothers and newborns from direct medical cost, they still experience significant indirect costs to access the MNCH services. The indirect costs include transportation cost, meal expenses for the patient and the accompanying persons in the case of hospitalization, other consumables at the healthcare facilities, as well as illness-related income loss. As the scheme for the poor in JKN still faces mistargeting problem, the uninsured poor suffer from a considerable financial burden as a consequence of all direct medical and indirect costs in times of pregnancy, delivery, and postnatal cares. Those substantial OOP expenditures may force poor households to withdraw their savings or sell their assets—things that, in the short run or in the long run, can affect their economic status.

Conclusion:

Extending the coverage of social health insurance to the poor may improve both access to and affordability of healthcare, particularly the MNCH services. However, the gaps in financial protection may persist. Some components of indirect cost, such as that for the transportation during the referral process for people living in remote areas, can possibly be taken over by local governments. But, other kinds of cost, such as illness-related income loss, go beyond the scope of social health insurance.

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