Effects of decentralized health care financing on maternal care in Indonesia

We exploit variation in the design of sub-national health care financing initiatives in Indonesian districts to assess the effects of these local schemes on maternal care from 2004 to 2010. The analysis is based on a district pseudo-panel, combining data from a unique survey among District Health Offices with the Indonesian Demographic and Health Surveys, the national socioeconomic household surveys, and the village census. Our results show that these district schemes contribute to an increase in antenatal care visits and the probability of receiving basic recommended antenatal care services, and a decrease in home births, especially for households that fall outside the target group of the national health insurance programs. The variation in scheme design is a source of impact heterogeneity. Including antenatal and delivery services explicitly in benefit packages and contracting local rather than national health care providers increases the positive effects on maternal care.