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Effects of Decentralized Health-Care Financing on Maternal Care in Indonesia

Author

Listed:
  • Renate Hartwig
  • Robert Sparrow
  • Sri Budiyati
  • Athia Yumna
  • Nila Warda
  • Asep Suryahadi
  • Arjun S. Bedi

Abstract

We exploit variation in the design of subnational health-care financing initiatives in Indonesian districts to assess the effects of these local schemes on maternal care from 2004 to 2010. The analysis is based on a district pseudopanel, combining data from a unique survey among District Health Offices with the Indonesian Demographic and Health Surveys, the national socioeconomic household surveys, and the village census. Our results show that these district schemes contribute to an increase in antenatal care visits and the probability of receiving basic recommended antenatal care services for households that are not targeted by the national health insurance programs. We observe a decrease in home births. However, there is no effect on professional assistance at birth. We also observe variation in scheme design across districts as well as constraints to the effectiveness of local schemes. Including antenatal and delivery services explicitly in benefits packages and contracting local rather than national health-care providers increases the effects on maternal care. Increasing population coverage reduces effectiveness, delineating limitations to local funding and risk pooling. Furthermore, we do not find any effects for districts outside Java and Bali, where access to basic health care remains a key policy concern.

Suggested Citation

  • Renate Hartwig & Robert Sparrow & Sri Budiyati & Athia Yumna & Nila Warda & Asep Suryahadi & Arjun S. Bedi, 2019. "Effects of Decentralized Health-Care Financing on Maternal Care in Indonesia," Economic Development and Cultural Change, University of Chicago Press, vol. 67(3), pages 659-686.
    • Handle: RePEc:ucp:ecdecc:doi:10.1086/698312
    DOI: 10.1086/698312
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    1. Powell-Jackson, Timothy & Hanson, Kara, 2012. "Financial incentives for maternal health: Impact of a national programme in Nepal," Journal of Health Economics, Elsevier, vol. 31(1), pages 271-284.
    2. Long, Qian & Klemetti, Reija & Wang, Yang & Tao, Fangbiao & Yan, Hong & Hemminki, Elina, 2012. "High caesarean section rate in rural China: Is it related to health insurance (New Co-operative Medical Scheme)?," Social Science & Medicine, Elsevier, vol. 75(4), pages 733-737.
    3. Galiani, Sebastian & Gertler, Paul & Schargrodsky, Ernesto, 2008. "School decentralization: Helping the good get better, but leaving the poor behind," Journal of Public Economics, Elsevier, vol. 92(10-11), pages 2106-2120, October.
    4. Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2010. "Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 95-106, September.
    5. Faguet, Jean-Paul, 2004. "Does decentralization increase government responsiveness to local needs?: Evidence from Bolivia," Journal of Public Economics, Elsevier, vol. 88(3-4), pages 867-893, March.
    6. Endang L. Achadi & Anhari Achadi & Eko Pambudi & Puti Marzoeki, 2014. "A Study on the Implementation of Jampersal Policy in Indonesia," Health, Nutrition and Population (HNP) Discussion Paper Series 91325, The World Bank.
    7. Horrace, William C. & Oaxaca, Ronald L., 2006. "Results on the bias and inconsistency of ordinary least squares for the linear probability model," Economics Letters, Elsevier, vol. 90(3), pages 321-327, March.
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    More about this item

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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