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Abstract

The success of a country’s health development is marked by achieving fair access to healthcare and protecting the population from financial risks of health. Household spending on healthcare, or out-of-pocket (OOP) expenses, in Indonesia, remains far above the ideal limit set by the WHO. There is a noticeable disparity in OOP health expenditures across provinces in Indonesia. The five provinces with the highest per capita OOP expenses are on Java island. This high per capita OOP spending on Java indicates potential issues with access to healthcare services and financial protection in this region. This study aims to identify factors influencing household OOP health expenditures by considering regional effects in Java. The research utilizes secondary data from the 2022 National Socio-Economic Survey (Susenas) and data from BPS publications. The method used is spatial analysis with geographically weighted regression (GWR). The results indicate that all study variables affect household OOP health expenditures in Java’s districts and cities. Life expectancy, average years of schooling, transportation expenses to health facilities, the doctor-to-population ratio per 1,000 people, and the percentage of inpatient cases positively correlate with household OOP health spending. The variables of health insurance ownership percentage and poverty rate negatively correlate with household OOP health expenditures in each district and city in Java. However, the significance of local coefficients shows variation in the number of towns and neighborhoods for each variable. Thus, different variables influence each district and city on Java.

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Bahasa Abstract

Parameter keberhasilan pembangunan kesehatan suatu negara ditandai dengan terwujudnya akses yang adil dan melindungi risiko finansial masyarakat terhadap kesehatan. Belanja rumah tangga untuk kesehatan atau out of pocket (OOP) di Indonesia masih jauh di atas batas ideal yang ditetapkan WHO. Kesenjangan pengeluaran kesehatan OOP terlihat antarprovinsi di Indonesia. Lima provinsi dengan pengeluaran OOP per kapita tertinggi di Indonesia terdapat di Pulau Jawa. Tingginya pengeluaran OOP per kapita di Pulau Jawa ini mengindikasikan terdapat potensi masalah akses terhadap layanan serta perlindungan terhadap pelayanan dan biaya kesehatan di Pulau Jawa. Tujuan penelitian ini adalah mengetahui faktor-faktor yang memengaruhi pengeluaran kesehatan OOP rumah tangga dengan memperhatikan efek kewilayahan di Pulau Jawa. Penelitian ini menggunakan data sekunder yang bersumber dari Susenas 2022 dan data publikasi BPS. Metode analisis yang digunakan adalah analisis kewilayahan dengan metode Geographically Weighted Regression (GWR). Hasil penelitian menunjukkan bahwa seluruh variabel penelitian berpengaruh terhadap pengeluaran kesehatan OOP rumah tangga di kabupaten/kota Pulau Jawa. Variabel umur harapan hidup, rata-rata lama sekolah, pengeluaran transportasi ke fasilitas kesehatan, rasio dokter per 1.000 penduduk, dan persentase kejadian rawat inap memiliki hubungan positif dengan pengeluaran kesehatan OOP rumah tangga. Variabel persentase kepemilikan jaminan kesehatan dan persentase penduduk miskin memiliki hubungan negatif terhadap pengeluaran kesehatan OOP rumah tangga di setiap kabupaten/kota di Pulau Jawa. Namun, hasil signifikansi koefisien lokal ditemukan bahwa terdapat perbedaan jumlah kabupaten/kota pada setiap variabel. Dengan demikian, terdapat perbedaan variabel-variabel yang berpengaruh untuk setiap kabupaten/kota di Pulau Jawa.

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