Food Insecurity and Healthcare Utilization in Indonesia: Evidence from Indonesian National Household Surveys
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Abstract
Treatment for sicknesses in healthcare is a crucial determinant to improve health. In Indonesia, the unmet need for healthcare is common for people in the lower economic group. This study aims to examine how food insecurity affects outpatient care using the indicators of food insecurity to highlight individuals with high health risks and experiencing problems with limited resources. The data used in this study consisted of 159,236 individuals representing different age ranges from the 2017 National Socio-Economic Survey (SUSENAS) and the 2018 Village Potential Census (PODES). Data were analyzed using ivprobit to address bias due to the endogeneity in the food insecurity variables. The results indicate that a higher food insecurity score will increase the chances of not accessing modern healthcare for outpatient care when sick. Several variables like sex, types of residence, number of household members living together, access to healthcare, health insurance, social protection, and illness characteristic were also found to influence individual behavior in not utilizing modern healthcare for outpatient care. This study suggests that policymakers should pay attention to the utilization of modern healthcare, especially for outpatient care in groups experiencing food insecurity.
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• Abadie, A., Athey, S., Imbens, G., & Wooldridge, J. (2017). When should you adjust standard errors for clustering? NBER Working Paper Working Paper No. 24003. https://doi.org/10.3386/w24003
• Abegaz, K. H. (2017). Determinants of food security: Evidence from Ethiopian Rural Household Survey (ERHS) using pooled cross-sectional study. Agriculture & Food Security, 6, Article 70. https://doi.org/10.1186/s40066-017-0153-1
• Adelaja, A., George, J., Miyahara, T., & Penar, E. (2019). Food insecurity and terrorism. Applied Economic Perspectives and Policy, 41(3), 475–497. https://doi.org/10.1093/aepp/ppy021
• Andarini, S., Arif, A. Z., al Rasyid, H., Wahono, C. S., Kalim, H., & Handono, K. (2019). Factors associated with health care seeking behavior for musculoskeletal pain in Indonesia: A cross‐sectional study. International Journal of Rheumatic Diseases, 22(7), 1297–1304. https://doi.org/10.1111/1756-185x.13536
• Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284
• Awiti, J. O. (2014). Poverty and health care demand in Kenya. BMC Health Services Research, 14, Article 560. https://doi.org/10.1186/s12913-014-0560-y
• Badan Ketahanan Pangan. (2018). Peta Ketahanan dan Kerentanan Pangan 2018 [Food Security and Vulnerability Atlas 2018]. http://bkp.pertanian.go.id/storage/app/media/Pusat%20Ketersediaan/FSVA%202019%20FINAL.pdf
• Baer, T. E., Scherer, E. A., Fleegler, E. W., & Hassan, A. (2015). Food insecurity and the burden of health-related social problems in an urban youth population. Journal of Adolescent Health, 57(6), 601–607. https://doi.org/10.1016/j.jadohealth.2015.08.013
• Becker, G. S. (1962). Investment in human capital: A theoretical analysis. Journal of Political Economy, 70(5, Part 2), 9–49. https://doi.org/10.1086/258724
• Becker, M. H. (1974). The health belief model and sick role behavior. Health Education & Behavior, 2(4), 409–419. https://doi.org/10.1177/109019817400200407
• Berkowitz, S. A., Seligman, H. K., Meigs, J. B., & Basu, S. (2018). Food insecurity, healthcare utilization, and high cost: A longitudinal cohort study. The American Journal of Managed Care, 24(9), 399–404. https://pubmed.ncbi.nlm.nih.gov/30222918/
• Beverly, S. G. (2001). Measures of material hardship: Rationale and recommendations. Journal of Poverty, 5(1), 23–41. https://doi.org/10.1300/J134v05n01_02
• Bhattacharya, J., Timothy, H., & Tu, P. (2014). Health Economics. Palgrave Macmillan.
• Bishwajit, G., & Yaya, S. (2017). Household food insecurity is independently associated with poor utilization of maternal healthcare services in Bangladesh. Facets, 2(2), 969–983. https://doi.org/10.1139/facets-2017-0018
• Blum, H. L. (1981). Planning for Health: Generics for the Eighties. Human Science Press.
• BPS-Statistics Indonesia. (2019). Indikator Tujuan Pembangunan Berkelanjutan (TPB) Indonesia 2019 [Sustainable Development Indicators Indonesia 2019]. https://zalamsyah.staff.unja.ac.id/wp-content/uploads/sites/286/2020/04/Indikator-Tujuan-Pembangunan-Berkelanjutan-TPB-Indonesia-2019.pdf
• BPS-Statistics Indonesia. (2020, December 29). Indikator Kesehatan 1995-2018 [Health Indicator 1995-2018] [Data set]. https://www.bps.go.id/statictable/2009/03/10/1559/indikator-kesehatan-1995-2018.html
• Campbell, C. C. (1991). Food insecurity: A nutritional outcome or a predictor variable? The Journal of Nutrition, 121(3), 408–415. https://doi.org/10.1093/jn/121.3.408
• Erlangga, D., Ali, S., & Bloor, K. (2019). The impact of public health insurance on healthcare utilisation in Indonesia: Evidence from panel data. International Journal of Public Health, 64, 603–613. https://doi.org/10.1007/s00038-019-01215-2
• FAO, IFAD, UNICEF, WFP, & WHO. (2018). The State of Food Security and Nutrition in the World 2018: Building Climate Resilience for Food Security. FAO. https://www.fao.org/3/I9553EN/i9553en.pdf
• Food and Agriculture Organization (FAO), & Voices of the Hungry (VoH). (2015). Modeling Food Insecurity in Bivariate and Regression Analyses. VoH Project. https://www.fao.org/3/bp091e/bp091e.pdf
• Gao, M., & Yao, Y. (2006). Gender gaps in access to healthcare in rural China. Economic Development and Cultural Change, 55(1), 87–107. https://doi.org/10.1086/505720
• Gauthier, B., & Wane, W. (2011). Bypassing health providers: The quest for better price and quality of healthcare in Chad. Social Science & Medicine, 73(4), 540–549. https://doi.org/10.1016/j.socscimed.2011.06.008
• Grobler, W. C. J. (2016). Perceptions of poverty: A study of food secure and food insecure households in an urban area in South Africa. Procedia Economics and Finance, 35, 224–231. https://doi.org/10.1016/s2212-5671(16)00028-9
• Grossman, M. (1972). On the concept of health capital and demand for health. Journal Political Economy, 80(2), 223–255. https://doi.org/10.1086/259880
• Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839. https://doi.org/10.1377/hlthaff.2015.0645
• Hardouin, J.-B. (2008). IMPUTERASCH: Stata module to impute binary data by a Rasch model. https://econpapers.repec.org/RePEc:boc:bocode:s456805
• Hausmann-Muela, S., Ribera, J. M., & Nyamongo, I. (2003). Health-seeking behaviour and the health system response. DCPP Working Paper No. 14.
• Heller, P. S. (1982). A model of the demand for medical and healthcare in Peninsular Malaysia. Social Science & Medicine, 16(3), 267–284. https://doi.org/10.1016/0277-9536(82)90337-9
• Herman, D., Afulani, P., Coleman-Jensen, A., & Harrison, G. G. (2015). Food insecurity and cost-related medication underuse among non-elderly adults in a nationally representative sample. American Journal of Public Health, 105(10), e48–e59. https://doi.org/10.2105/AJPH.2015.302712
• Iceland, J., & Bauman, K. J. (2007). Income poverty and material hardship: How strong is the association? The Journal of Socio-Economics, 36(3), 376-396. https://doi.org/10.1016/j.socec.2006.12.003
• Kementerian PPN/Bappenas. (2019). Kajian Sektor Kesehatan: Penguatan Sistem Pelayanan Kesehatan [Health Sector Study: Strengthening the Health Service System]. https://www.bappenas.go.id/files/5715/9339/2399/FA_Preview_HSR_Book09.pdf
• Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to healthcare among low-income Americans. Journal of General Internal Medicine, 21, 71–77. https://doi.org/10.1111/j.1525-1497.2005.00278.x
• Leyva-Flores, R., Kageyama, M. L., & Erviti-Erice, J. (2001). How people respond to illness in Mexico: Self-care or medical care? Health Policy, 57(1), 15–26. https://doi.org/10.1016/s0168-8510(00)00136-6
• Ma, C. T., Gee, L., & Kushel, M. B. (2008). Associations between housing instability and food insecurity with health care access in low-income children. Ambulatory Pediatrics, 8(1), 50–57. https://doi.org/10.1016/j.ambp.2007.08.004
• Mahapatro, S. R. (2020). Socioeconomic inequality in healthcare utilization in India: Is health insurance a way out? Journal of Population and Social Studies, 28(1), 89–102. https://doi.org/10.25133/jpssv28n1.006
• Napitupulu, B. (1968). Hunger in Indonesia. Bulletin of Indonesian Economic Studies, 4(9), 60–70. https://doi.org/10.1080/00074916812331331172
• Nasrudin, R. (2019). Three essays on livelihood and development in Indonesia [Unpublished doctoral thesis]. Australian National University. http://hdl.handle.net/1885/165454
• Nielsen, R. B., Garasky, S., & Chatterjee, S. (2010). Food insecurity and out-of-pocket medical expenditures: Competing basic needs? Family and Consumer Sciences Research Journal, 39(2), 137–151. https://doi.org/10.1111/j.1552-3934.2010.02052.x
• Olasehinde, N. (2018). Healthcare seeking behavior in Nigeria. Journal of Population and Social Studies, 26(3), 207–218. https://doi.org/10.25133/JPSSv26n3.015
• Peters, D. H., Garg, A., Bloom, G., Walker, D. G.,Brieger, W. R., & Rahman, M. H. (2008). Poverty and access to healthcare in developing countries. Annals of the New York Academy of Sciences, 1136(1), 161–171. https://doi.org/10.1196/annals.1425.011
• Radimer, K. L., Olson, C. M., & Campbell, C. C. (1990). Development of indicators to assess hunger. The Journal of Nutrition, 120(Suppl 11), 1544–1548. https://doi.org/10.1093/jn/120.suppl_11.1544
• Sclafer, J., Slamet, L. S., & de Visscher, G. (1997). Appropriateness of self-medication: Method development and testing in urban Indonesia. Journal of Clinical Pharmacy and Therapeutics, 22(4), 261–272. https://doi.org/10.1046/j.1365-2710.1997.10075100.x
• Seligman, H. K., Jacobs, E. A., López, A., Tschann, J., & Fernandez, A. (2012). Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care, 35(2), 233–238. https://doi.org/10.2337/dc11-1627
• Sen, A. (1981). Poverty and famines: An essay on entitlement and deprivation. Oxford University Press.
• Shariff, Z. M., & Lin Khor, G. (2008). Household food insecurity and coping strategies in a poor rural community in Malaysia. Nutrition Research and Practice, 2(1), 26–34. https://dx.doi.org/10.4162%2Fnrp.2008.2.1.26
• Smith, J. P. (1999). Healthy bodies and thick wallets: The dual relation between health and economic status. Journal Economic Perspectives, 13(2), 144–166. https://doi.org/10.1257/jep.13.2.145
• Sparrow, R., Suryahadi, A., & Widyanti, W. (2013). Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme. Social Science & Medicine, 96, 264–271. https://doi.org/10.1016/j.socscimed.2012.09.043
• Taffa, N., & Chepngeno, G. (2005). Determinants of healthcare seeking for childhood illnesses in Nairobi slums. Tropical Medicine & International Health, 10(3), 240–245. https://doi.org/10.1111/j.1365-3156.2004.01381.x
• van den Berg, G. J., Pinger, P. R., & Schoch, J. (2016). Instrumental variable estimation of the causal effect of hunger early in life on health later in life. The Economic Journal, 126(591), 465–506. https://doi.org/10.1111/ecoj.12250
• Vidyattama, Y., Miranti, R., & Resosudarmo, B. P. (2014). The role of health insurance membership in health service utilisation in Indonesia. Bulletin of Indonesian Economic Studies, 50(3), 393-413. https://doi.org/10.1080/00074918.2014.980380
• von Grebmer, K., Bernstein, J., Patterson, F., Sonntag, A., Klaus, L. M., Fahlbusch, J., Towey, O., Foley, C., Gitter, S., Ekstrom, K., & Fritschel, H. (2018). Global Hunger Index 2018: Forced Migration and Hunger. Concern Worldwide. https://www.concern.net/insights/global-hunger-index-2018-report
• Wagstaff, A. (2002). Poverty and health sector inequalities. Bulletin of the World Health Organization, 80(2), 97–105. https://apps.who.int/iris/handle/10665/268713
• Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., Hatcher, A. M., Frongillo, E. A., & Bangsberg, D. R. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition, 94(6), 1729S-1739S. https://doi.org/10.3945/ajcn.111.012070
• WHO Commission on Macroeconomics and Health, & World Health Organization. (2001). Macroeconomics and health: Investing in health for economic development: Executive summary/report of the Commission on Macroeconomics and Health. World Health Organization. https://apps.who.int/iris/handle/10665/42463
• Widodo, M. A. (2016, November 18). Long-term effects of childhood malnutrition on education and health: Evidence from Indonesia [Paper presentation]. Ph.D. Seminar (Econ), Canberra, Australia.
• Wooldridge, J. M. (2010). Econometric Analysis of Cross Section and Panel Data (2nd edition). MIT Press.
• Wooldridge, J. M. (2013). Introductory Econometrics A Modern Approach (5th edition). Cengage Learning.
• World Bank Group. (2016). Indonesia Health Financing System Assessment: Spent more, right and better. World Bank. http://hdl.handle.net/10986/25363
• World Bank Group. (2019). World Development Indicators | DataBank. World Bank. https://databank.worldbank.org/source/world-development-indicators
• World Health Organization. (2002). Promoting rational use of medicines: Core components. https://apps.who.int/iris/handle/10665/67438
• Young, S., Wheeler, A. C., McCoy, S. I., & Weiser, S. D. (2014). A Review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS and Behavior, 18, 505–515. https://doi.org/10.1007/s10461-013-0547-4