Does National Health Protection Cover the Vulnerable Groups in Indonesia? A Case Study of Waste Pickers in Surabaya

Abstract

The National Health Protection (NHP) of Indonesia is a pro-poor social health insurance as the government pays the monthly premium for the poor. A waste picker is classified as an urban poor group needing affordable or free access to health care. This study explores the extent to which the NHP protects the health of waste pickers and provides them with quality health care. For this mixed-method study, 342 waste pickers completed the survey, 40 engaged in interviews, and 15 participated in Natural Group Discussions. The study found that 20% of waste pickers were not enrolled in NHP due to issues such as incorrect validation of poverty, discrimination, illegal fees, nepotism, unaffordable premiums, and lack of interest in purchasing the health plan. Among those who were enrolled, waste pickers expressed satisfaction with the health care they received and the behavior of the staff. However, they did criticize certain aspects such as waiting times, service gaps between full-paying and subsidized patients, suspicion of the quality of medicines, complicated medical administration procedures, and inflexibility of the capitation system. The study concludes that despite the NHP, poor groups remain vulnerable to accessing free health care.

Food Insecurity and Outpatient Care Utilization Among Indonesian Older Adults

“…Thus, while health insurance is still required to access outpatient care services, it is insufficient to ensure that food insecure older adults get access to outpatient care. Prior research has revealed that urban poor Indonesians with national health insurance have faced issues such as waiting times, service gaps between fullpaying and subsidized patients, and the inflexibility of the capitation system, par ticularly at PHC providers, 23 which may necessitate addi tional selffunding. As a result of the aforementioned factors, food insecure older adults with low resources may be dis couraged from seeking outpatient care.…”