Is there an ex-ante moral hazard on Indonesia’s health insurance? An impact analysis on household waste management behavior

Beta Yulianita Gitaharie; Rus’an Nasrudin; Ayu Putu Arantza Bonita; Lovina Aisha Malika Putri; Muhammad Abdul Rohman; Dwini Handayani

doi:10.1371/journal.pone.0276521

Peer Review History

Original SubmissionJanuary 6, 2022
24 Apr 2022 Decision Letter - Kumaran Subramanian, Editor PONE-D-22-00455Is there an ex-ante moral hazard on Indonesia’s health insurance? An impact analysis on household waste management behaviorPLOS ONE Dear Dr. Gitaharie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 08 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. 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Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide Additional Editor Comments (if provided): Dear authors The authors should carry out the reviewers suggestions Need to improve the quality of the manuscript Check the typo graphical errors in the manuscript The article needs major revision for further process [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Authors, The manuscripts is well-organized and well written. The topic is interesting and significant in the current situation. I would suggest few minor revisions to enhance the quality of your manuscript. 1. You have mentioned the data was collected from surveys in 2007 and 2014. A short explanation how these data still relevant for current situation in Indonesia would be useful. 2. I'm sure the findings of this study would be relevant for the Indonesian government. But, you need to be more precise on stating how the government can use this findings. Thank you and good luck! ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0276521.r001
Revision 1
17 Jun 2022 Author Response The followings are our responses to the referee’s comments. Comment #1 You have mentioned the data was collected from surveys in 2007 and 2014. A short explanation how these data still relevant for current situation in Indonesia would be useful. Response: Thank you for raising this important concern. Accordingly, we provide the following responses. • IFLS is a longitudinal survey that have been conducted since 1993 by Rand Corporation with the latest available wave was from 2014 survey (https://www.rand.org/well-being/social-and-behavioral-policy/data/FLS/IFLS.html). The use of a longitudinal survey in our study is advantageous because as it is better in capturing the respondents’ changes both in the outcome and variable of interest as they are followed over time. Moreover, in our best of knowledge, there is no other potential data for such purpose. The socioeconomic national survey (SUSENAS) has some thematic survey in particular year containing health aspects, such as in 2017. In addition, the Demographic Health Survey/DHS (SDKI) and the Basic Health Research Survey (RISKESDAS) are potential but do not contain our variables of interest. Nevertheless, these datasets are cross-sectional so they are less ideal for our purpose. • The dynamic variation that we explore was coming from 2014 as the latest, we argue that the data still provide basis for internal validity for the particular time period. Moreover, the external validity of the estimate might be differ for the recent time period. As depicted in Table 2, there has been tendency of increasing share of subsidized insurance group toward recent time. Accordingly, we can expect that the low base effect could drive a larger effect in our estimate compared to scenario when we use the most recent data. • Accordingly, we add a sentence to briefly explain why we use 2014 as the end line period in lines 68-70; “We exploit the variation of the household’s health insurance between the baseline period of 2007 and the end line period of 2014 as the most suitable recent data that is available for analysis.2 ---- 2 To the best of our knowledge, there is no other potential data for such purpose. The socioeconomic national survey (SUSENAS) has some thematic surveys in a particular year containing health aspects, such as in 2017. In addition, the Demographic Health Survey/DHS (SDKI) and the Basic Health Research Survey (RISKESDAS) are potential but do not contain our variables of interest. Nevertheless, these datasets are cross-sectional so they are less ideal for our purpose.” • and qualify its external validity toward the recent time context in lines 479-482: “On the external validity, we acknowledge the potential low base effect in which the point of estimates might be overstated compared to the recent situation as the share of the subsidized group becomes larger. Accordingly, we infer that our estimates serve as the upper bound of the effects.” • Moreover, the data used in our study are also still relevant as the dynamics of outcome and key variables of interest have not changed much since 2014 (see Table 2). • We also added the percentage of insurance beneficiary households in Panel B Table 2. Comment #2 I'm sure the findings of this study would be relevant for the Indonesian government. But, you need to be more precise in stating how the government can use these findings. Response: Thank you to referee for this important suggestion. Accordingly, we provided the following revisions: • We added the following sentences in the Introduction (lines 90-92): “The finding of this study is expected to help the Indonesian government to design a better intervention concerning adverse side effect of health insurance subsidy.” • Also, we revised the following sentences in the Conclusion (lines 483-491): “The finding of this study will help the government not only focus on the curative action but also on preventive ones by imposing stricter prohibitions for subsidized insurance recipients to not burn their domestic waste and manage them properly. However, the Indonesian government needs to train the lower-income group to manage waste sorting and recycling. It is also likely the training result gives the lower-income group opportunity for income-generating activities. The reduced waste burning will lead to a healthier household living environment which, in turn, will reduce the potential government extra budget to mitigate health-related problems due to waste burning air pollution.” https://doi.org/10.1371/journal.pone.0276521.r002
25 Jul 2022 Decision Letter - Alison Parker, Editor PONE-D-22-00455R1Is there an ex-ante moral hazard on Indonesia’s health insurance? An impact analysis on household waste management behaviorPLOS ONE Dear Dr. Gitaharie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The second reviewer has confirmed the high quality of the paper, however the first reviewer has some further minor comments which shouldn't be too problematic to address. Please submit your revised manuscript by Sep 08 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Alison Parker Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The study has been well written, so does the introduction section. It provides clear argument about the importance of the study. However, I would like to recommend one small thing for this section. The authors have mention that they have found an evidence of ex-ante moral hazard in the subsidized health insurance recipients on how they manage their household waste. The insured households are more likely to burn their domestic waste than the uninsured. How do we know that this act of burning was a result of subsidizing health insurance? was it more related to a common behaviour of group of people instead? Another explanation about how do you relate the health insurance to a waste management would also be useful for this section. In the the conclusion, the authors offer recommendation for Indonesian government that they need to advise the insured families not to burn their waste. Is it the advise you really want to take out from your study findings? I believe the authors are able to provide some more ideas to their government about waste management that they believe it relate to the provision of health insurance. Reviewer #2: The manuscript has been revised thoroughly, the data support the conclusions, the statistical analysis has been performed appropriately and rigorously, the authors have made all data underlying the findings in their manuscript fully available, the manuscript is presented in an intelligible fashion and written in standard English. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0276521.r003
Revision 2
18 Sep 2022 Author Response A point-by-point response to the reviewer are provided in the attached file (Response to Reviewers_Revision2.docx) Attachments Attachment Submitted filename: Response to Reviewers_Revision 2.docx https://doi.org/10.1371/journal.pone.0276521.r004
10 Oct 2022 Decision Letter - Alison Parker, Editor Is there an ex-ante moral hazard on Indonesia’s health insurance? An impact analysis on household waste management behavior PONE-D-22-00455R2 Dear Dr. Gitaharie, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Alison Parker Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: The revised manuscript version is well improved. Wish the findings of this manuscript can elevate well-waste-management in Indonesia. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0276521.r005
Formally Accepted
5 Dec 2022 Acceptance Letter - Alison Parker, Editor PONE-D-22-00455R2 Is there an ex-ante moral hazard on Indonesia’s health insurance? An impact analysis on household waste management behavior Dear Dr. Gitaharie: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Alison Parker Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0276521.r006

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