2000年-世界发展银行全球_Health_Care_During_Financial_Crisis___What_Can_We_Learn_from_the_Indonesian_National_Socioeconomic_Survey__33页_762kb

Summary: Health Care During Financial Crisis – What Can We Learn from the Indonesian National Socioeconomic Survey?

Core Content

This paper analyzes the impact of Indonesia's financial crisis on health care utilization, using data from the Indonesian National Socioeconomic Survey (SUSENAS) for the years 1995, 1997, and 1998. The study focuses on changes in health indicators, health expenditures, and the choice of health care providers during this period.

Main Points

1. Morbidity Trends

• Overall morbidity (self-reported illness in the previous month) decreased slightly from 25.5% in 1995 to 24.4% in 1997, but then increased to 25.5% in 1998.
• Disruptive morbidity (illness that interferes with daily activities) followed a similar pattern, rising from 9.6% in 1995 to 10.6% in 1998.
• Regional differences were significant:
  • Urban areas in Kalimantan saw a substantial increase in morbidity.
  • The "other islands" region (Nusa Tengara, Timor, Maluku, Irian Jaya) experienced a continuous decline in morbidity.
  • Java/Bali was the only region where morbidity increased in both urban and rural areas.
• Morbidity increased for children and the elderly, while it decreased for the working-age population (25–64 years).

2. Health Expenditures

• Health expenditures increased slightly in rural areas (from 1.5% to 1.6% of household expenditure over 1995–98).
• Urban areas showed a U-shaped pattern, with some fluctuations.
• The contact rate for modern care (public and private) dropped significantly from 1997 to 1998, with public services declining more sharply than private ones.
• The contact rate for public health centers (puskesmas) fell from 4.66% in 1995 to 3.25% in 1998.
• Self-treatment increased from 32% in 1995 to 62% in 1998, possibly due to changes in questionnaire design.

3. Choice of Health Care Providers

• The use of public sector health services dropped more than private services.
• Public outpatient user rates remained relatively constant from 1995 to 1997 but declined significantly in 1998.
• Private outpatient user rates increased slightly from 1995 to 1997 but remained stable in 1998.
• The contact rate for public hospitals dropped from 7.0% in 1995 to 5.0% in 1998, while private hospitals remained about the same.
• The contact rate for posyandu (village health posts) dropped almost by half, from 1.9% in 1995 to 0.74% in 1998.

4. Hypotheses on the Drop in Public Health Utilization

• Hypothesis 1: Relative price increases in public services.
  • The study found only modest changes in nominal prices for public health centers and subsidiary health centers.
  • Prices for other public services (e.g., hospitals, clinics) increased significantly, but this could not fully explain the drop in utilization.
• Hypothesis 2: Affordability issues for the poor.
  • The drop in public health utilization could not be fully attributed to income changes.
  • The poor were still more likely to use public services than the rich, suggesting that the drop was not solely due to affordability.
• Hypothesis 3: Deterioration in quality and accessibility of public services.
  • This explanation is supported, as the study found that the decline in public service use was likely due to reduced access and/or quality, leading to a shift to private services.

Key Information

• Data Sources: SUSENAS (Indonesian National Socioeconomic Survey), covering 1995, 1997, and 1998.
• Sample Sizes:
  • 1995: 873,643 individuals
  • 1997: 887,266 individuals
  • 1998: 880,040 individuals
• Key Findings:
  • The drop in public health service utilization was more significant than for private services.
  • The financial crisis had a greater impact on certain groups, such as children and the elderly.
  • The poor still had higher morbidity than the rich, but the rich experienced a decline in health service use.
  • The shift from public to private health services was linked to perceived quality and accessibility issues in the public sector.

Conclusion

The paper highlights that the financial crisis in Indonesia had a complex impact on health care utilization. While the overall trend showed a slight increase in morbidity, the most significant change was the decline in the use of public health services. The study suggests that the deterioration in access and quality of public services, rather than affordability, was the primary reason for this shift. These findings provide a baseline for future research on the health sector's response to economic crises.