[show abstract][hide abstract] ABSTRACT: Indonesia is one of the largest consumers of tobacco in the world, however there has been little work done on the economics addiction of tobacco. This study provides an empirical test of a rational addiction (henceforth RA) hypothesis of cigarette demand in Indonesia.
Four estimators (OLS, 2SLS, GMM, and System-GMM) were explored to test the RA hypothesis. The author adopted several diagnostics tests to select the best estimator to overcome econometric problems faced in presence of the past and future cigarette consumption (suspected endogenous variables). A short-run and long-run price elasticities of cigarettes demand was then calculated. The model was applied to individuals pooled data derived from three-waves a panel of the Indonesian Family Life Survey spanning the period 1993-2000.
The past cigarette consumption coefficients turned out to be a positive with a p-value < 1%, implying that cigarettes indeed an addictive goods. The rational addiction hypothesis was rejected in favour of myopic ones. The short-run cigarette price elasticity for male and female was estimated to be-0.38 and -0.57, respectively, and the long-run one was -0.4 and -3.85, respectively.
Health policymakers should redesign current public health campaign against cigarette smoking in the country. Given the demand for cigarettes to be more prices sensitive for the long run (and female) than the short run (and male), an increase in the price of cigarettes could lead to a significant fall in cigarette consumption in the long run rather than as a constant source of government revenue.
[show abstract][hide abstract] ABSTRACT: Using aggregated panel data taken from three waves of the Indonesian Family Life Survey (1993-2000), this article tests the myopic addiction behaviour of cigarette demand. Sensitivity analysis is done by examining a rational addiction behavior of cigarette demand. The results provide support for myopic addiction. The short- and long-run price elasticities of cigarette demand are estimated at -0.28 and -0.73 respectively. Excise taxes are more likely to act as an effective tobacco control in the long-run rather than a major source of government revenue.
International Journal of Environmental Research and Public Health 06/2010; 7(6):2473-85. · 2.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper assesses the extent of the financial burden due to out-of-pocket payments for health care incurred by people living with HIV (PLHIV) and the effect of this burden on their financial capacity. Data were collected in a cross-sectional survey of 353 PLHIV from three cities in Indonesia (Jakarta, Jogjakarta and Merauke). Respondents in Jakarta were sampled from one hospital and one non-governmental organization working with PLHIV. In Jogjakarta and Merauke, all HIV patients on antiretroviral therapy (ART) who came to selected hospitals during the interview period were asked to participate in the survey. The survey collected data on the frequency and extent of payments for HIV-related care, with answers cross-checked against medical records. Results show that PLHIV had different burdens of payments in the different geographical areas. On average, respondents in Jogjakarta spent 68%, and PLHIV on ART in Jakarta spent 96%, of monthly expenditure for HIV-related care, indicating a substantial financial burden for many ART patients. These patients depended on several sources of finance to cover the costs of their care, with donations from their immediate family being the most common method, selling assets and payments from personal income being the second most common method in Jakarta and Jogjakarta, respectively. Most PLHIV in these two areas did not have insurance. In Merauke, there were little observed out-of-pocket payments because the government covers medical costs via the local budget and health insurance for the poor. The results of this study confirm previous findings that providing subsidized ART drugs alone does not ensure financial accessibility to HIV care. Thus, the government of Indonesia at central and local levels should consider covering HIV care additional to providing antiretroviral drugs free of charge. Social health insurance should also be encouraged.
Health Policy and Planning 02/2010; 25(4):272-82. · 2.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: We apply several estimators to Indonesian household data to estimate the relationship between health insurance and the number of outpatient visits to public and private providers. Once endogeneity of insurance is taken into account, there is a 63 percent increase in the average number of public visits by the beneficiaries of mandatory insurance for civil servants. Individuals' decisions to make first contact with private providers is affected by private insurance membership. However, insurance status does not make any difference for the number of future outpatient visits.
International Journal of Environmental Research and Public Health 01/2010; 7(1):9-27. · 2.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: Estimations of the demand for healthcare often rely on estimating the conditional probabilities of being ill. Such estimate poses several problems due to sample selectivity problems and an under-reporting of the incidence of illness. This study examines the effects of health insurance on healthcare demand in Indonesia, using samples that are both unconditional and conditional on being ill, and comparing the results.
The demand for outpatient care in three alternative providers was modeled using a multinomial logit regression for samples unconditional on being ill (N = 16485) and conditional on being ill (N = 5055). The ill sample was constructed from two measures of health status - activity of daily living impairments and severity of illness - derived from the second round of panel data from the Indonesian Family Life Survey. The recycling prediction method was used to predict the distribution of utilization rates based on having health insurance and income status, while holding all other variables constant.
Both unconditional and conditional estimates yield similar results in terms of the direction of the most covariates. The magnitude effects of insurance on healthcare demand are about 7.5% (public providers) and 20% (private providers) higher for unconditional estimates than for conditional ones. Further, exogenous variables in the former estimates explain a higher variation of the model than that in the latter ones. Findings confirm that health insurance has a positive impact on the demand for healthcare, with the highest effect found among the lowest income group.
Conditional estimates do not suffer from statistical selection bias. Such estimates produce smaller demand effects for health insurance than unconditional ones do. Whether to rely on conditional or unconditional demand estimates depends on the purpose of study in question. Findings also demonstrate that health insurance programs significantly improve access to healthcare services, supporting the development of national health insurance programs to address under-utilization of formal healthcare in Indonesia.
[show abstract][hide abstract] ABSTRACT: Indonesia had joined the 3 by 5"strategy to provide free antiretroviral (ARV) drugs in selected public hospitals. In Indonesia 10% of 130,000 PLWHA would be in immediate need for ART. Fifty percent of these - 6,500 PLWHA - should have received ART by end of 2005. The Government of Indonesia eventually decided to set the target at 10,000 by end of 2005. However, this target was not met. The objective of the study is to explore current and potential barriers toward the access to treatment for HIV and to determine in particular the role of financial factors. Using a structured questionnaire, data was collected from 352 respondents consisting of randomly selected PLWHA from three provinces in Indonesia, representing high and low cases of HIV/AIDS. The study collected information on access to ART, and several determinants of access including financial capability, knowledge, stigma, severity etc. To estimate the demand for ART in terms of the probability of accessing of ART, the study used a discrete choice model. The dependent variable is in the form of whether the ART accessed or not, and we found the the logistic model best fit the data set. The results confirm that the most influential factor in the access to ART is severity, followed by stigma and financial factor. Policy implications of the study will be discussed.
[show abstract][hide abstract] ABSTRACT: To study the gender role in child health care utilization in Nepal.
We analysed 8112 individual observations of age </=15 years from 2847 households in 274 communities, obtained from the 1996 Nepal Living Standard Survey. Four steps of a health seeking action, namely illness reporting, choosing an external care, choosing a specific health care provider, and spending money to treat the sick child, were examined using discrete/continuous choice models.
There was no statistically significant difference between boys and girls by demographic, socio-economic and geographical status in the sample. However, gender was associated with all four utilization decision steps. While the net effect of being a boy was modest in illness reporting (p<0.10), it appeared stronger in the choice of external care, in the choice of public provider and in the choice of expenditure with the private provider (p<0.05).
Gender role not only affects illness reporting but also affects the decision to choose a health care provider and how much to spend on the sick child, i.e. it affects the entire steps of a health seeking action.
Health Policy 10/2005; 74(1):100-9. · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees.
A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey. A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness. The model's coefficients were used to calculate the price responsiveness of utilization decisions.
Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month. Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers. The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16. As prices rise, the demand curve exhibits continuous and declining price elasticity. Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%. The differential in utilization across income groups was substantial after changes in fees were implemented.
While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest. Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue.
Bulletin of the World Health Organisation 05/2005; 83(5):338-44. · 5.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.
Health Policy and Planning 10/2004; 19(5):322-35. · 3.06 Impact Factor