Social assistance coverage and health service utilization in Indonesia: Evidence from a national cross-sectional survey

Problem considered Social assistance programs are widely used in LMICs to reduce poverty and strengthen household resilience. In Indonesia, major initiatives such as cash transfers, food assistance, and public health insurance subsidies aim to improve welfare and access to essential services, yet their effect on healthcare utilization remains unclear. This study examines the association between social assistance programs and healthcare utilization across urban and rural households. Methods This cross-sectional study analyzed data from the 2024 National Socioeconomic Survey (SUSENAS), including 1.2 million individuals. Outcomes included outpatient visits (past month) and inpatient care (past year). Multinomial logistic regression with survey weights was used to assess associations between social assistance, insurance, and healthcare utilization. Results Rural populations had lower education, greater reliance on public health insurance (75.50% vs. 67.94%), and higher social assistance receipt (49.10% vs. 47.70%) than urban populations. Urban households were wealthier and had higher private insurance coverage (3.40% vs. 1.24%). Inpatient utilization was higher in urban areas (4.11% vs. 3.23%; p=0.001). Public health insurance was the strongest predictor, increasing public hospital use up to eightfold (OR=7.62). Men were less likely to use services, while urban residence and higher wealth increased utilization. Inpatient private hospital use was highest among the richest households (OR=1.83; 95% CI: 1.62–2.07), with limited social assistance effects. Conclusion Social assistance alone has limited impact on healthcare utilization in Indonesia. Health insurance—particularly JKN—remains the primary driver, highlighting the need for better integration between social protection and health financing to improve equitable access.