The relationship between health insurance ownership and health service utilization, out-of-pocket expenses, and catastrophic health expenditure in the Special Region of Yogyakarta in 2023

Creating financial protection for the Indonesian people is one of the main functions of Universal Health Coverage. Implementing health insurance is expected to protect society from out-of-pocket expenditures. Catastrophic health expenditure can result in various financial consequences. This study aims to determine the relationship between health insurance ownership in households in the Special Region of Yogyakarta and the utilization of health services, out-of-pocket expenses, and catastrophic health expenditures. Studies have shown that having health insurance was associated with increased utilization of inpatient (OR) 3.20 (95% CI 2.16 4.75) and outpatient (OR) 2.08 (95% CI 1.66 2.61) health services compared to household members who did not have health insurance. Ownership of Health Insurance has a significant effect on out-of-pocket health (p<0.05) and is also associated with a greater likelihood of preventing catastrophic health expenditure at the 25% threshold (OR) 0.80 (95% CI 0.68-0.94). Ownership of Health Insurance is proven to be related to increased utilization of inpatient and outpatient care and have a significant effect to potentially decrease Out-of-Pocket Health Costs. It is crucial to optimize and expand the National Health Insurance program, provide financial protection, and reduce the financial burden on households in Indonesia due to catastrophic health spending.