IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0218519.html
   My bibliography  Save this article

The evolution of income-related inequalities in healthcare utilisation in Indonesia, 1993–2014

Author

Listed:
  • Joko Mulyanto
  • Dionne S Kringos
  • Anton E Kunst

Abstract

Objective: While the major policy changes in the Indonesian healthcare system over the last 25 years have been well documented, less is known about the accompanying changes in inequalities in healthcare utilisation during this period. Our study aimed to describe the trends in income-related inequalities in healthcare utilisation in Indonesia during the period 1993–2014. Methods: A repeated cross-sectional study was conducted using data from the Indonesian Family Life Surveys from 1993, 2000, 2007, and 2014. We measured outpatient and inpatient healthcare utilisation in public and private provider as well as the overall utilisation. Standardised prevalence rate and relative index of inequality (RII) were used to measure the extent of inequalities in healthcare utilisation by income level (income-related inequalities). Results: Relatively large income-related inequalities were observed in the utilisation of private outpatient care and public and private inpatient care in 1993. Income-related inequalities in public and private outpatient care utilisation decreased between 1993 and 2007 but increased in 2014. Income-related inequalities in public and private inpatient care utilisation continued to decrease between 1993 and 2014. The largest decrease was observed in private inpatient care utilisation. Conclusion: Income-related inequalities in all types of healthcare utilisation decreased until 2007. This trend continued until 2014 only for public and private inpatient care utilisation. This phenomenon may be explained by the changes to the healthcare system (e.g. expansion of the government health insurance programme and health sector decentralisation), which coincided with the changes in inequalities in healthcare utilisation in Indonesia.

Suggested Citation

  • Joko Mulyanto & Dionne S Kringos & Anton E Kunst, 2019. "The evolution of income-related inequalities in healthcare utilisation in Indonesia, 1993–2014," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-15, June.
    • Handle: RePEc:plo:pone00:0218519
    DOI: 10.1371/journal.pone.0218519
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218519
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0218519&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0218519?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Johar, Meliyanni & Soewondo, Prastuti & Pujisubekti, Retno & Satrio, Harsa Kunthara & Adji, Ardi, 2018. "Inequality in access to health care, health insurance and the role of supply factors," Social Science & Medicine, Elsevier, vol. 213(C), pages 134-145.
    2. Mackenbach, Johan P. & Kunst, Anton E., 1997. "Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe," Social Science & Medicine, Elsevier, vol. 44(6), pages 757-771, March.
    3. Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.
    4. Sukumar Vellakkal & S V Subramanian & Christopher Millett & Sanjay Basu & David Stuckler & Shah Ebrahim, 2013. "Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-12, July.
    5. O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
    6. Eddy van Doorslaer & Andrew M. Jones, 2004. "Income‐related inequality in health and health care in the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 605-608, July.
    7. Laia Palència & Albert Espelt & Maica Rodríguez-Sanz & Katia B. Rocha & M. Isabel Pasarín & Carme Borrell, 2013. "Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 211-219, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hernández-Quevedo, Cristina & Jones, Andrew M. & López-Nicolás, Angel & Rice, Nigel, 2006. "Socioeconomic inequalities in health: A comparative longitudinal analysis using the European Community Household Panel," Social Science & Medicine, Elsevier, vol. 63(5), pages 1246-1261, September.
    2. Mishra, Udaya S., 2016. "Measuring progress towards MDGs in child health: Should base level sensitivity and inequity matter?," Evaluation and Program Planning, Elsevier, vol. 58(C), pages 70-81.
    3. Muhammad Fikru Rizal & David W. Johnston & Nicole Black & Rohan Sweeney, 2024. "Mental Healthcare Access and the Treatment Gap in Indonesia," Papers 2024-16, Centre for Health Economics, Monash University.
    4. Joko Mulyanto & Dionne S. Kringos & Anton E. Kunst, 2019. "The accuracy of self-report versus objective assessment for estimating socioeconomic inequalities in disease prevalence in Indonesia," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(8), pages 1233-1241, November.
    5. Thrane, Christer, 2006. "Explaining educational-related inequalities in health: Mediation and moderator models," Social Science & Medicine, Elsevier, vol. 62(2), pages 467-478, January.
    6. Zhou, Guoliang & Chen, Ran & Chen, Mingsheng, 2020. "Equity in health-care financing in China during the progression toward universal health coverage," China Economic Review, Elsevier, vol. 61(C).
    7. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    8. Mohammad Abu-Zaineh & Habiba Romdhane & Bruno Ventelou & Jean-Paul Moatti & Arfa Chokri, 2013. "Appraising financial protection in health: the case of Tunisia," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 73-93, March.
    9. Wong, Irene O.L. & Cowling, Benjamin J. & Lo, Su-Vui & Leung, Gabriel M., 2009. "A multilevel analysis of the effects of neighbourhood income inequality on individual self-rated health in Hong Kong," Social Science & Medicine, Elsevier, vol. 68(1), pages 124-132, January.
    10. Sun, Xiaojie & Liu, Xiaoyun & Sun, Qiang & Yip, Winnie & Wagstaff, Adam & Meng, Qingyue, 2014. "The impact of a pay-for-performance scheme on prescription quality in rural China : an impact evaluation," Policy Research Working Paper Series 6892, The World Bank.
    11. Hwa-Kyung Lim & Young-Ho Khang, 2019. "Quantifying the impact of reducing socioeconomic inequalities in modifiable risk factors on mortality and mortality inequalities in South Korea," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(4), pages 585-594, May.
    12. Fanny Janssen & Anthe van den Hende & Joop de Beer & Leo van Wissen, 2016. "Sigma and beta convergence in regional mortality: A case study of the Netherlands," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 35(4), pages 81-116.
    13. Natasha Wood & David Bann & Rebecca Hardy & Catharine Gale & Alissa Goodman & Claire Crawford & Mai Stafford, 2017. "Childhood socioeconomic position and adult mental wellbeing: Evidence from four British birth cohort studies," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-13, October.
    14. Kate Birnie & Rachel Cooper & Richard M Martin & Diana Kuh & Avan Aihie Sayer & Beatriz E Alvarado & Antony Bayer & Kaare Christensen & Sung-il Cho & Cyrus Cooper & Janie Corley & Leone Craig & Ian J , 2011. "Childhood Socioeconomic Position and Objectively Measured Physical Capability Levels in Adulthood: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 6(1), pages 1-13, January.
    15. Teresa Leão & Inês Campos-Matos & Clare Bambra & Giuliano Russo & Julian Perelman, 2018. "Welfare states, the Great Recession and health: Trends in educational inequalities in self-reported health in 26 European countries," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-14, February.
    16. Hannelore Grande & Patrick Deboosere & Hadewijch Vandenheede, 2013. "Evolution of educational inequalities in mortality among young adults in an urban setting," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(6), pages 825-835, December.
    17. Wim Van Lancker & Joris Ghysels, 2013. "Great expectations, but how to achieve them? Explaining patterns of inequality in childcare use across 31 developed countries," Working Papers 1305, Herman Deleeck Centre for Social Policy, University of Antwerp.
    18. Green, Mark A., 2013. "The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002–2004 to 2008–2010," Social Science & Medicine, Elsevier, vol. 87(C), pages 93-98.
    19. Elena Cottini & Claudio Lucifora, 2013. "GINI DP 86: Inequalities at work Job quality, Health and Low pay in European Workplaces," GINI Discussion Papers 86, AIAS, Amsterdam Institute for Advanced Labour Studies.
    20. Hernández-Quevedo, Cristina & Jones, Andrew M. & Rice, Nigel, 2008. "Persistence in health limitations: A European comparative analysis," Journal of Health Economics, Elsevier, vol. 27(6), pages 1472-1488, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0218519. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.