Abstract: |
The implementation of national health insurance in Indonesia since 2014 has
brought out the missing middle problem in which the non-poor informal sectors
have remained uncovered from the health care due to self-enrollment.
Therefore, achieving UHC in Indonesia will take a long process, especially
when the proportion of non-poor informal sector in total population is large
enough. This study aims at examining three main issues that may have become
obstacles for informal sectors to join the program: (1) observing supply side
readiness, (2) examining affordable premium and willingness to pay of informal
sectors, and (3) exploring why informal workers have been reluctant to join
the national health insurance. This study reports that around 53.7% of Sub
National Government (SNG) faced a shortage of health facilities of 59,387
beds, though in some regions had surplus of beds (per 1000 people). This study
also finds that a single premium for all over Indonesia is unfair and
unaffordable for some people living in eastern part of Indonesia. Observing
400 households working in informal sectors and applying Triple Bounded
Dichotomies Choice Contingent Valuation Method (TCCVM) to observe the
Willingness to Pay (WTP), this study finds that around 70% of respondents had
the desire to join the health insurance, but their willingness to pay of the
premium was lower than the current rate. The current premium seemed less
affordable for informal sectors; thus, this created a barrier for them to
enthusiastically join the new health insurance program. Our econometric
estimations confirm that availability of hospital, insurance literacy,
experiences of inpatients and outpatients, number of family member, sex of
head of household, access to internet and household income are highly
correlated to the likelihood of informal sectors joining the national health
insurance (NHI). Moreover, in contrast with findings from many other studies,
the insurance premium is surprisingly not the main reason for informal sectors
to join the program; rather, the main obstacle is the lack of insurance
literacy. Consequently, the necessary condition for mandating informal sectors
to join the program is an improvement of insurance literacy, while the
sufficient conditions are supply-side readiness and affordable premium. This
study calls for a massive campaign to educate the public about the importance
of health insurance. |