Health Insurance

or expert consultation with key stakeholders or document reviews. Doing so could allow the team to accurately establish what proportion of line items can be attributed to nutrition.9 For example, the Indonesia NPER applied disaggregation weights to the National Health Insurance (Jaminan Kesehatan Nasional ) program to determine its contribution to nutrition (box 3.5). If evidence-based disaggregation weights can be constructed (Yes in Step 7), the NPER has the option of applying them to the relevant line items. If that is not the case (No in Step 7), the NPER should use the full cost without the use of more subjective disaggregation weights and noting the possibility of overestimation. In the past, SUN included guidance for NPERs to use less precise normative disaggregation weights.10 In its updated guidance, however, SUN no longer recommends this practice because of its highly subjective nature.11 Practitioners need to be fully aware that the use of disaggregation weights is a temporary solution until the accounting system can tag line items at a more detailed level, making the process of weighting redundant.

Personnel cost. Personnel cost is a common form of a bundled budget (No in Step 6). Fracassi et al. (2020) state that in most cases the associated personnel costs are likely to be presented at the ministry level, meaning that it is not possible to know what personnel are allocated to which program or service delivery channel, although in some cases there may be disaggregation at the departmental or program level. The NPER should clearly state how personnel costs are presented in the data source and treated to determine nutrition expenditures. When personnel costs are presented at the ministry level, SUN guidance suggests using the most disaggregated data and estimating the proportion of

BOX 3.5

Using weights to assess the contribution of Indonesia’s National Health Insurance

Indonesia’s Ministry of Health has a single program to provide insurance premium assistance through the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program, with the objective to cover 96.8 million citizens. If the entire JKN budget of 26.7 trillion Indonesian rupiah (Rp; fiscal year 2019) is ascribed as nutrition expenditures, it will be a gross overestimation. Therefore, the Indonesia nutrition public expenditure review used weights according to the following assumptions or steps:

Ministry of Health (024) • Activity code: 5610. JKN. • Output code: 501. Number of populations would be covered by JKN. • volume: 96.8 million people would be covered by

JKN. • Budget allocation for this activity output: Rp 26.7 trillion (US$1.8 billion). • Weighting assumptions: Only 2 percent of pregnant women and 10 percent of children under five years old are part of the 96.8 million JKN participants (or weight is 12 percent). It is estimated that only 70 percent of insurance services for pregnant women and children will be related to efforts to reduce stunting. • Formula: 12 percent × 70 percent × Rp 26.7 trillion. • Of the total budget of Rp 26.7 trillion, only Rp 2.2 trillion (US$160 million) is assumed to contribute to efforts to reduce stunting (the nutrition goal used in the nutrition public expenditure review).

Source: World Bank, forthcoming.