Jakarta, Indonesia
Jakarta, Indonesia

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Sparrow R.,Wageningen University | Sparrow R.,Erasmus University Rotterdam | Sparrow R.,Australian National University | Budiyati S.,SMERU Research Institute | And 4 more authors.
Health Policy and Planning | Year: 2017

Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features. © 2016 The Author.


Suryadarma D.,SMERU Research Institute | Poesoro A.,SMERU Research Institute | Akhmadi,SMERU Research Institute | Budiyati S.,SMERU Research Institute | And 2 more authors.
Food Policy | Year: 2010

Indonesia's urban centers recently underwent an explosion of supermarkets. With cheaper, higher quality commodities and better services, supermarkets have the potential to drive traders in traditional markets out of business. In this paper, we evaluate whether this is indeed the case. We find that traditional traders experienced declines in their business. However, both qualitative and quantitative findings indicate that the main cause of decline is not supermarkets. Instead, traditional markets are plagued with internal problems and face increasingly bitter competition from street vendors. Therefore, the policy recommendations include strengthening traditional traders and seriously tackling the problem of street vendors. © 2009 Elsevier Ltd. All rights reserved.


Sparrow R.,Australian National University | De Poel E.V.,Erasmus University Rotterdam | Hadiwidjaja G.,SMERU Research Institute | Yumna A.,SMERU Research Institute | And 2 more authors.
Health Economics (United Kingdom) | Year: 2014

We assess the economic risk of ill health for households in Indonesia and the role of informal coping strategies. Using household panel data from the Indonesian socio-economic household survey (Susenas) for 2003 and 2004, and applying fixed effects Poisson models, we find evidence of economic risk from illness through medical expenses. For the poor and the informal sector, ill health events impact negatively on income from wage labour, whereas for the non-poor and formal sector, it is income from self-employed business activities which is negatively affected. However, only for the rural population and the poor does this lead to a decrease in consumption, whereas the non-poor seem to be able to protect current household spending. Borrowing and drawing on family network and buffers, such as savings and assets, seem to be key informal coping strategies for the poor, which may have negative long-term effects. While these results suggest scope for public intervention, the economic risk from income loss for the rural poor is beyond public health care financing reforms. Rather, formal sector employment seems to be a key instrument for financial protection from illness, by also reducing income risk. Copyright © 2013 John Wiley & Sons, Ltd.


Sparrow R.,Australian National University | Suryahadi A.,SMERU Research Institute | Widyanti W.,SMERU Research Institute
Social Science and Medicine | Year: 2013

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. © 2012 Elsevier Ltd.


Nurbani R.I.,SMERU Research Institute
IDS Bulletin | Year: 2015

Rising food prices, increasing urbanisation, rising numbers of working women and reduced time for care has led to more children eating more pre-prepared and instant food in Indonesia. Besides the durability of much packaged food, its price is also less volatile and often cheaper than fresh food. The rising consumption of pre-prepared and instant food is a worrying trend for Indonesia because this newly middle-income country faces a problem of hidden hunger. Among households who took part in the Life in a Time of Food Price Volatility study, we found widespread concerns about the quality, nutritional value and safety of snacks and other instant foods eaten by children. We also heard about the effect on children's relations with their elders. This article looks at links between food prices and changing food habits and argues that children's snacking, while appearing micro, is creating macro-dynamics related to nutrition security and social wellbeing. © 2015 Institute of Development Studies.


PubMed | Australian National University, Erasmus University Rotterdam and SMERU Research Institute
Type: | Journal: Health policy and planning | Year: 2016

Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features.

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