Out-of-pocket expenditure in Indonesia is significant and despite the introduction of social health insurance in 2014 remains one of the main funding sources for health care. In 2013, it was estimated to be 49 per cent out of total health expenditure; however, the figure has been reported to have declined to 34 per cent in 2017.

Despite this high proportion, the share of families facing catastrophic out-of-pocket expenditure (more than 25% of household expenditure) remains at only about 1 per cent. On the other hand, approximately 7 million households (8% of households) were reported to have been impoverished due to health-related out-of-pocket payments (World Bank, 2016b, p.4). The WHO, therefore, groups Indonesia among countries with high out-of-pocket expenditures (Agustina et al., 2019, p.85; WHO, 2017, pp.126,133; World Bank, 2016b, p.4).

Even though access to services is increasing, there appears to be a lack in uptake with about 50 per cent of those entitled to outpatient care and 20 per cent of those entitled to inpatient care not taking up services. This may be due to issues with access, waiting times, quality of care, and providers falsely charging for treatments and medication (Agustina et al., 2019, p.90).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

World Bank. (2016b). Indonesia Health Financing System assessment: spend more, spend right & spend better. http://documents.worldbank.org/curated/en/453091479269158106/pdf/110298-REVISED-PUBLIC-HFSA-Nov17-LowRes.pdf

World Bank. (2017). Indonesia Can Improve Opportunities for and Protection of Its Migrants Working Abroad. Press Release. https://www.worldbank.org/en/news/press-release/2017/11/28/indonesia-can-improve-opportunities-for-and-protection-of-its-migrants-working-abroad