Targeting the Poor in Times of Crisis: The Indonesian Health Card

48 Pages Posted: 19 Dec 2006

See all articles by Robert A. Sparrow

Robert A. Sparrow

Wageningen UR - Development Economics Group; Erasmus University Rotterdam (EUR) - Institute of Social Studies (ISS); IZA Institute of Labor Economics

Date Written: October 2006


This paper looks at targeting performance of the Indonesian health card programme that was implemented in August 1998 to protect access to health care for the poor during the Indonesian economic crisis. By February 1999, 22 million people had received a health card. The health card provided a user fee waiver for public health care. Targeting of the health card was pro-poor, but with considerable leakage to the non-poor. Utilisation of the health card for outpatient care was also pro-poor, but conditional on ownership, the middle quintiles were more likely to use the card.

Targeting of the health card followed a decentralised design combining geographic targeting with community based targeting. This design facilitated the rapid implementation of the programme, but targeting performance suffered from inadequate information on the regional impact of the crisis, while at local level not all barriers to accessing health care services were overcome by the health card. Indirect and direct costs of seeking health care seem to be the main deterrent to using the health card, which are higher in more remote areas.

Micro-simulations show that geographic targeting can contribute considerably to improving targeting performance, but most of the targeting gains are to be made at the community level.

This study highlights the need for adequate and up to date social welfare indicators. In addition, further research would need to focus on how local knowledge can be utilised for signalling poverty dynamics and local barriers to access.

Keywords: Health care access, economic crisis, Indonesia, outpatient care, poverty, price subsidy, targeting

JEL Classification: H51, I18, I38

Suggested Citation

Sparrow, Robert A., Targeting the Poor in Times of Crisis: The Indonesian Health Card (October 2006). Available at SSRN: or

Robert A. Sparrow (Contact Author)

Wageningen UR - Development Economics Group ( email )

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Erasmus University Rotterdam (EUR) - Institute of Social Studies (ISS) ( email )

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Den Haag, 2518 AX

IZA Institute of Labor Economics

P.O. Box 7240
Bonn, D-53072

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