Our study examines the progressivity index of Out-of-pocket (OOP) payment, the effects of mandatory of health insurance on reducing OOP payment and inequality of OOP among difference regions. This is a secondary analysis research study design by using panel data from the three waves of the Indonesian Family Life Survey (IFLS) year 1993, 1997 and 2000. To estimate the regressiveness of OOP payments, we used the Kakwani Index of progressivity, whether to assess the effects of mandatory health insurance on household OOP medical expenditures used linear regression with natural log transformation, and to assess inequality OOP payment different region used mean differences in OOP payment. The study found that OOP medical expenditures in Indonesia had likely a progressive pattern. Since percentage of people under insurance scheme were very low, this situation showed that people in low income level could not afford medical services and only the better off who able to access medical services. Mandatory health insurance found to have no significant effect to OOP medical expenditure, mean that mandatory health insurances were not able to reduce OOP payment. There was inequality of OOP payment among different regions in Indonesia because of unequal distribution of health care resources, health seeking behavior difference and regional income level difference. Establishing compulsory health insurance would ensure fairness and equitable health care financing and reorganize health care delivery system will create assurance to access health care services for all people in Indonesia.
