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Healthcare utilization and outcomes for insured dependent children: evidence from Indonesia

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In this study, I examine the role of health insurance cover in improving access to healthcare services and consequently its role in improving health outcomes for dependent children. I utilize differences in temporal variation of insurance cover for dependent children and their cousins, within the same Indonesian household to estimate the effect. By comparing dependent children of different biological parents, living in the same household, this study avoids potential confounders for healthcare demand, such as health endowment due to nutrition and hygiene. I find that dependent children of government employees have increased access to health insurance. In terms of healthcare use, I find no impact of insurance in providing access to preventive care as an outpatient. Instead, insurance status positively impacted first time and repeat visits to private facilities for curative care only. Insured children were 4.4 per cent more likely, than uninsured cousins, to access first-time curative care and make 63 per cent more repeat visits as an outpatient. In contrast, for inpatient services, insured children sought care at public facilities. Insurance did not have a positive impact on health outcomes for dependents. The results are robust to an instrumental variable estimation, alongside household fixed effects, which addresses concerns on potential endogeneity of insurance cover.

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  1. Based on calculation from the Indonesian family life survey sample.

  2. see Sect. 2 for details.

  3. BPDPK—Badan Penyelenggara Dana pemeliharaan Kesehatan.

  4. Data structure in the first IFLS round (1993) does not enable identification of hierarchical family relationships and is thus not used for this study.

  5. For sensitivity checks of the results, I also create an extended sample, which retains households with either atleast one uninsured sibling or uninsured cousin in step 2.

  6. Jamsostek was the Askes equivalent for formal workers in private corporations and their families. Due to opt-out conditions, the coverage for parents was sparse and such dependents are not used in this study.

  7. People either having systolic pressure (arteries pressure during contraction of the heart muscle) of 140–160 mmHg or having diastolic pressure (pressure during rest period intervening heart beats) of 90 to 100 mmHg were categorized as having Stage-1 hypertension.

  8. Estimates and post-estimation tests are retrieved using the xtivreg2 command in Stata (Schaffer 2010).

  9. The Sanderson and Windmeijer (2016) F-statistic, a notable correction over the Angrist-Pischke F, is only purposeful in the case of multiple endogenous regressors.

  10. For repeated observations of dependents within a household over time, one can reasonably expect correlation in error terms.

  11. Similar to the previous sample, I exclude ever married or employed dependents.

  12. The point estimate for a 10% rise in X in a lin-log model is 0.095 * \({\hat{\beta }}\); \(\log (110/100)=0.095\).


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The author declares that no funding was received to assist with conducting this study or in the preparation of this manuscript.

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Correspondence to Kalyan Kolukuluri.

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Appendix: sensitivity check—using the sibling and cousins sample

Appendix: sensitivity check—using the sibling and cousins sample

Table 11 Summary statistics for dependent children
Table 12 Outpatient healthcare use (fixed effects IV-2SLS estimates)
Table 13 Inpatient healthcare use (fixed effects IV-2SLS estimates)
Table 14 Health outcomes (fixed effects IV-2SLS estimates)

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Kolukuluri, K. Healthcare utilization and outcomes for insured dependent children: evidence from Indonesia. Empir Econ 63, 945–977 (2022).

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