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"Jatuh miskin karena sakit adalah situasi yang lazim terjadi. Biaya perawatan kesehatan menjadi beban keuangan yang tidak dapat diprediksi dan bersifat katastropik. Asuransi kesehatan umum digunakan sebagai bagian dari perencanaan keuangan guna memberikan proteksi keuangan dan pengelolaan risiko. Asuransi kesehatan sosial merupakan jenis asuransi kesehatan yang dapat dijangkau oleh seluruh kelompok masyarakat, termasuk kelompok miskin yang sulit menjangkau asuransi kesehatan swasta. Akan tetapi, peran dan fungsi asuransi kesehatan sosial belum dapat terjelaskan dengan baik, terutama di Low-and Middle-Income Countries (LMICs) yang memiliki skema asuransi kesehatan sosial yang masih prematur. Penelitian ini bertujuan untuk mengeksplorasi peran asuransi kesehatan sosial dalam memberikan proteksi keuangan di tiga LMICs yang berada di kawasan Asia Tenggara, yakni Indonesia, Filipina, dan Kamboja. Selain itu, penelitian ini juga melakukan analisis lanjutan terkait variasi cakupan asuransi kesehatan sosial guna memetakan ketimpangan antarkelompok. Penelitian ini menggunakan sumber data dari IFLS dan DHS yang diolah menggunakan metode IV-2SLS, Quantile Regression, dan Logistic. Hasil penelitian menemukan hanya program asuransi kesehatan sosial di Indonesia dan Kamboja yang berhasil memberikan proteksi keuangan bagi rumah tangga, sedangkan asuransi kesehatan sosial di Filipina hanya memberikan proteksi keuangan bagi pengobatan rawat inap. Walau demikian, cakupan asuransi kesehatan sosial di Indonesia dan Filipina masih terkonsentrasi pada kuintil kekayaan yang makin tinggi. Adapun, asuransi kesehatan sosial di Kamboja masih terlimitasi dengan tingkat cakupan yang masih sangat rendah.

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Impoverishment due to illness is a common case. Health care costs are often unpredictable and become catastrophic financial burden for households. Health insurance is generally used in financial planning to provide financial protection and risk management. As part of health insurance, social health insurance has the ability to reach all levels of society, including the poor who are unable to use private health insurance. However, the role and function of social health insurance cannot be well explained, especially in Low-and Middle-Income Countries (LMICs) which have premature social health insurance schemes. This study aims to explore the role of social health insurance in providing financial protection in three LMICs in Southeast Asia, namely Indonesia, the Philippines, and Cambodia. In addition, this study also conducted further analysis related to variations in social health insurance coverage in order to map inequality between groups. This study uses data from IFLS and DHS which are processed using IV-2SLS, Quantile Regression, and Logistic methods. The results found that only social health insurance programs in Indonesia and Cambodia have succeeded in providing financial protection for households, whereas social health insurance in the Philippines provide financial protection only for the inpatient groups. However, social health insurance coverage in Indonesia and the Philippines is still concentrated in higher wealth quintiles. Meanwhile, social health insurance in Cambodia is still limited with a very low level of coverage."

"This book aims to present the first comprehensive synthesis of the context and impact of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) and to offer insights on successful and sustainable interventions and policies that work for at-risk populations. It includes 12 chapters divided into 3 parts. Part I focuses on the state of the problem and state of knowledge on the epidemiology and burden of the major NCDs. Three chapters review the epidemiology and burden of cardiovascular diseases and diabetes (Chapter 1), cancers (Chapter 2) and neurodegenerative diseases such as dementia and Parkinson's disease (Chapter 4). Two chapters focus on the co-morbid and multi-morbid interactions between the major NCDs and infectious diseases like HIV, tuberculosis and malaria (Chapter 3) and mental health disorders (Chapter 5). Part II focuses on best practices and innovation in research and intervention. Four chapters discuss key issues on this theme including health systems strengthening (Chapter 6), population surveillance (Chapter 7), community-based interventions (Chapter 8) and self-help approaches to NCD care (Chapter 9). Part III focuses on policy development and implementation. Three chapters offer a comprehensive analysis of existing policies relevant to NCD prevention and control. They focus on policies that work, as well as discussing the lessons that can be learned from infectious disease control (Chapter 10), NCD control in high-income countries (Chapter 11) and the current policy issues and activities arising from the 2011 UN High Level Meeting on NCDs and leading to a post-2015 global health agenda (Chapter 12)."

"Both developing countries and those in transition struggle to meet the health needs of their populations with minimal resources available. Planning by the public sector should enable decisions to be made, but is often poorly practised. This book provides accessible techniques to improve planning processes and puts this in the wider global context."

"Pasca diimplementasikannya program Jaminan Kesehatan Nasional (JKN), peningkatan pemanfaatan pelayanan kesehatan terjadi pada setiap jenis kepesertaan. Meskipun mengalami tren peningkatan, sasaran utama program JKN yaitu peserta PBI masih dianggap belum optimal dalam pemanfaatan pelayanan kesehatan, berbeda dengan jenis kepesertaan PBPU, PPU, dan Bukan Pekerja yang memiliki tingkat pemanfaatan pelayanan kesehatan yang optimal. Penelitian ini bertujuan untuk melihat bagaimana pengaruh pendapatan terhadap pemanfaatan pelayanan kesehatan berdasarkan jenis kepesertaan JKN. Menggunakan data sekunder dari data Klaim Pelayanan Kesehatan BPJS Kesehatan tahun 2015 - 2018 dengan pendekatan metode analisa deskriptif dan estimasi persamaan regresi ordinary least square dan probit ordinal, diperoleh bahwa pendapatan yang diproyeksikan melalui jenis kepesertaan memiliki pengaruh terhadap tingkat pemanfaatan pelayanan kesehatan di antara peserta jaminan kesehatan nasional. Peserta PBI yang berasal dari kelompok pendapatan rendah memiliki periode perawatan kesehatan yang lebih lama, biaya pengeluaran kesehatan yang tinggi, dan tingkat keparahan penyakit yang lebih berat saat melakukan perawatan kesehatan dibandingkan dengan peserta yang berasal dari kelompok pendapatan menengah atas. Hasil penelitian ini menjelaskan kunjungan pemanfaatan pelayanan kesehatan peserta PBI yang rendah diakibatkan perilaku untuk mengobati sendiri dan pengetahuan yang rendah akan jaminan kesehatan nasional.

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After the implementation of the National Health Insurance (JKN) program, an increase in the utilization of health services occurred in each type of participation. Although experiencing an increasing trend, the main target of the JKN program, namely PBI participants, is still considered not optimal in the utilization of health services, in contrast to the types of PPU, PBPU, and Non-Workers participation which have an optimal level of utilization of health services. This study aims to see how income affects the utilization of health services based on the type of JKN membership. Using secondary data from BPJS Health Health Service Claims data in 2015 - 2018 with a descriptive analysis method approach and estimation of regression equations ordinary least squares and ordinal probit, it was found that the projected income through the type of participation has an influences on the level of utilization of health services among national health insurance participants. PBI participants from low-income groups had longer periods of health care, higher health expenditures, and more severe disease severity during health care than participants from upper-middle-income groups. The results of this study explain the low utilization of PBI participants of health service visits due to self-medicating behavior and low knowledge of national health insurance."

"Penelitian ini bertujuan untuk mengevaluasi program Jaminan Kesehatan Nasional dengan menganalisis pendapatan iuran dan beban Dana Jaminan Sosial Kesehatan tahun 2014-2018 untuk mengetahui penyebab terjadinya defisit. Data kualitatif penelitian ini adalah hasil wawancara dengan pihak internal BPJS Kesehatan sedangkan data kuantitatif adalah laporan keuangan DJS Kesehatan dan BPJS Kesehatan dari tahun 2014-2018. Berdasarkan analisis pendapatan iuran dan pendapatan yang dilakukan, ditemukan bahwa pendapatan iuran dalam lima tahun terakhir lebih rendah dibandingkan dengan beban biaya manfaat yang dibayarkan. Biaya manfaat yang paling menyerap beban manfaat BPJS Kesehatan adalah pelayanan pada rawat inap tingkat lanjutan. Rawat inap tingkat lanjutan ini merujuk pada Rumah Sakit yang bekerja sama dengan BPJS Kesehatan.

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This study aimed to evaluate the National Health Insurance program by analyzing the health income and expenses of DJS Kesehatan to determine the cause of the deficit. The qualitative data of this study are the results of interviews with internal of BPJS Kesehatan, while quantitative data are the financial reports of the DJS Health and BPJS Kesehatan year 2014-2018. The analysis showed that health income in the last five years was lower than the cost of benefits paid by BPJS Kesehatan. The cost of benefits that most absorbs the burden of benefits of BPJS Health is service at advanced hospitalization which refers to the hospital in collaboration with BPJS Kesehatan."