Date of Award

2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Health Care Management & Economics

First Advisor

Mark V. Pauly

Abstract

The government of Indonesia aims to achieve Universal Health Coverage by 2019 through the consolidation of fragmented schemes and the expansion of coverage to nonpoor informal sector populations through partially subsidized premiums. In doing so, Indonesia faces a challenge common to developing countries of trying to cover its large informal sector population. Based on data up through 2015, we analyze multiple dimensions of this coverage problem. Chapter One looks at the non-price determinants of enrollment for the large informal sector population to understand why less than 19 percent of the nonpoor informal sector are enrolled in SHI. Chapter Two uses propensity score matching with difference in difference analysis and exploits the differential payroll tax imposed by marital status to analyze the social health insurance reform’s impact on the formal sector labor market. Chapter Three compares naïve models and models that address potential endogeneity to look at the health utilization, financial protection, and health outcome impacts among the nonpoor informal sector. The reform resulted in a 1.6 percentage point increase in informal employment relative to a counterfactual decreasing trend in informalization. It increased public outpatient utilization but did not improve financial protection or health outcomes. Short of increasing resources to provide more generous resources, cost-sharing requirements and redesigning benefits packages coupled with investments in health sector inputs might enhance the demand for publicly provided health care services and address SHI deficits.

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