Meskipun Jaminan Kesehatan Nasional (JKN) Indonesia mendaftarkan lebih dari 270 juta anggota pada tahun 2024, rumah tangga pertanian di daerah pedesaan tetap rentan terhadap kesulitan keuangan yang terkait dengan kesehatan. Penelitian ini mengestimasi efek kausal dari asuransi kesehatan yang disubsidi pemerintah, khususnya skema Penerima Bantuan Iuran (PBI) dan pendahulunya, Jamkesmas dan Askeskin, terhadap catastrophic health expenditure (CHE) dan pemiskinan di kalangan rumah tangga pertanian di Indonesia. Dengan menggunakan data Indonesia Family Life Survey (IFLS 2007 dan 2014), penelitian ini menggunakan metode Propensity Score Matching-Difference-in-Differences (PSM-DiD) untuk memperkirakan Average Treatment Effect on the Treated (ATT). CHE diukur pada empat ambang batas, 10%, 25%, dan 40?ri total pengeluaran, dan 40?ri kapasitas pembayaran. Pemiskinan ditangkap melalui status pemiskinan lebih lanjut dan kesenjangan kemiskinan. Hasil menunjukkan bahwa asuransi bersubsidi tidak secara signifikan mengurangi probabilitas CHE pada ambang batas apa pun, yang mencerminkan kedalaman manfaat yang terbatas daripada kegagalan program. Namun, asuransi secara signifikan mengurangi kemungkinan pemiskinan lebih lanjut sekitar 44% (OR = 0,556, p < 0> 2 ha) menunjukkan penurunan kesenjangan kemiskinan yang signifikan. Temuan ini menunjukkan bahwa asuransi kesehatan bersubsidi terutama berfungsi sebagai instrumen perlindungan kemiskinan dan pelancaran konsumsi daripada mitigator CHE langsung untuk rumah tangga pertanian, dengan implikasi penting bagi desain kebijakan cakupan kesehatan universal di Indonesia.
Despite Indonesia's National Health Insurance (Jaminan Kesehatan Nasional/JKN) enrolling over 270 million members by 2024, agricultural households in rural areas remain disproportionately vulnerable to financial hardship related to health. This study estimates the causal effect of government-subsidized health insurance, specifically the Penerima Bantuan Iuran (PBI) scheme and its predecessors, Jamkesmas and Askeskin, on catastrophic health expenditure (CHE) and impoverishment among agricultural households in Indonesia. Using two waves of the Indonesian Family Life Survey (IFLS 2007 and 2014), this study applies Propensity Score Matching combined with Difference-in-Differences (PSM-DiD) to estimate the Average Treatment Effect on the Treated (ATT). CHE is measured at four thresholds, 10%, 25%, and 40% of total expenditure, and 40% of capacity to pay. Impoverishment is captured through further impoverishment status and poverty gap. Results indicate that subsidized insurance does not significantly reduce CHE probability at any threshold, reflecting limited benefit depth rather than program failure. However, insurance significantly reduces the likelihood of further impoverishment by approximately 44% (OR = 0.556, p < 0> 2 ha) exhibit significant reductions in the poverty gap. These findings suggest that subsidized health insurance primarily functions as a poverty-protection and consumption-smoothing instrument rather than a direct CHE mitigator for agricultural households, with important implications for the design of universal health coverage policy in Indonesia.
Kata Kunci :
catastrophic health expenditure, impoverishment, Rumah Tangga Pertanian, JKN, PSM-DiD
