Abstract
Background
The Indonesian government has been implementing the National Health Insurance Policy (Jaminan Kesehatan Nasional-JKN) since 2014. The utilization of family planning service is one of the programs to increase maternal and child health status that is included in the benefit package in JKN. This study aimed to describe determinants and to evaluate JKN based on equity indicators, especially in family planning services.
Methods
Data were obtained from the 2012-2016 National Socio-Economic Survey (SUSENAS) of Indonesia. Contraceptive Prevalence Rate (CPR) and Long-acting contraceptives (LACs) use were used as indicators to evaluate family planning utilization. Chi-square and logistic regression tests were used to analyze the data. Respondents were married women between 15 and 49 years of age.
Results
There was no progress in CPR after the implementation of JKN. At the national level, CPR decreased within five years (2012-2016). Decreasing in urban areas and in the group that does not have health insurance were more than in rural areas and in the group that has health insurance. Utilization of non-LACs, especially injection (56%-57%) and pill (21%-24%), were still high within 2012-2016. At the national level, LACs use increased 3.18% between 2012-2016 (15.54%-18.72%). Increasing in urban areas and in the group that has subsidized health insurance were more than in rural areas and in the group that does not have subsidized. Health insurance ownership, the geography factor, education, household economic correlated with contraceptive use (p<0.05) in 2015 and 2016, but this correlation was inversely proportional. Conversely, all of the determinants were positively associated with LACs use (p<0.05).
Conclusions
Up to 2016, the JKN program did not increase CPR. Conversely, the JKN program obtained only small increases in LACs use. LACs use in rural areas is less than in urban areas. JKN program can increase LACs use in the group that has subsidized health insurance. CPR and LACs coverage could be increased by health system improvement and the social approaches, specifically through improving supply-side and regulations, increasing coordination among multiple agencies in the family planning program, and promoting family planning based on values and norms in the society.
The role of socio-economic factors in the non renewal decision making of national health insurance policy holders in the bekwai municipal
