Equity in Utilization of Inpatient forNational Health Insurance (JKN) Program in Indonesia

Ahmad Nizar Shihab, A. Armyn Nurdin, Abd. Kadir Abd. Kadir, Hasbullah Thabrany, Idrus Paturusi

Abstract


Background: Indonesia is targeting to achieve Universal Health Coverage (UHC) in 2019. Currently, the National Health Insurance program (JKN) has been running since it was first started at January 1, 2014 and includes as many as 171 million participants from 254 million targeted population of Indonesia as efforts in achieving UHC. Objective: The aim of this study was to evaluate the effect of JKN against the equity in the utilization of inpatient care in thegovernment hospital (RS) and private hospitals before the implementation of JKN in 2013 and one year after JKN implemented in 2015 into 4 main groups: health insurance, geographic (rural and urban), income per capita, and education groups. Methods: This study used mixed method data collection techniques by using quantitative data obtained from secondary data of the National Socioeconomic Survey (Susenas) 2013 and 2015, and BPJS (Social Security Agency) of Health 2014-2015. The qualitative data obtained from the study of literature (desk review). Data analysis was performed by considering the percentage, delta, ratio, and odds ratio of utilization of inpatient care in government and private hospitals. Results: Based on the analysis of the fourgroups studied, showed that the JKN program improve equity and increase public access to the utilization of inpatient both at the Government and Private Hospital especially for the JKN participants, ruralpopulation, lowest income groups and less educated group.

Health insurance membershipp group: more patients using health services use health insurance both in government and at private hospitals, but the number of JKN card owner is the highest in government hospital. Conversely, those with private insurance use more health services in private hospitals. Geographic groups (rural and urban): JKN increase greater equity for rural people than urban communities. The increase in the highest access especially in utilization of health services in private hospitals.  The access for rural communities in private hospitals increase for about 127% compared to the urban population that only increased by 47%.

Groups of per capita income: increase in access is highest in quintile 1 compared with quintile 5.  In the government hospital, the increase in access to health service of the poor is about 97% compared with the rich that only about 25%. While in private hospitals, the access increasesfor the low income group occurs by 336% compared with the rich, which increased only 20%. Education groups: JKN used by all education groups either higher education or lower education to health services at government and private hospitals. The increase in access impacts primarily to the low education group (<=elementary school).Conclussion: Results of this study showed that the increase of equity for JKN card members in inpatient utilization especially impact at the Government Hospital. JKN program also increase the equity of rural communities in accessing inpatient care at government hospitals and private hospitals. Group of the lowest income also acquire equity improvements in inpatient utilization. Additionally, the program also includes the entire community both for high and low education group, however improvement of equity mainly impacts the low education group.

 


Keywords


JKN; UHC; equity; inpatient utilization.

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