Inequities of Access, Utilization and Clinical Outcome of Lung Cancer in Indonesia

Background: Indonesia integrated all social health insurance and social assistance program into the National Health Insurance Scheme (NHIS) aiming to achieve universal health coverage by 2019. Currently, 194 million people are registered in the NHIS. Lung cancer absorbed a significant amount of the NHIS Indonesia and one of the leading cause of deaths among men in Indonesia. Lung cancer is rising major public health concern due to a high prevalence of smokers yet most lung cancer is diagnosed at late stage leading to short survival rate in Indonesia. Aim: This study aimed at investigating access, utilization, and clinical outcomes of lung cancer's patients. The second aim is to investigate differences in access to treatments of lung cancer patients among different member groups of the NHIS. Methods: The data were drawn from a 2014-2015 claim of the NHIS. The number of lung cancer patients of the outpatient's care was 5939 in 2014 and was 6595 in 2015. The number of inpatients diagnosed with lung cancer was 8969 and 9455 respectively for 2014 and 2015. Descriptive analysis was performed to investigate the differences in access, utilization (consumption), and in clinical outcome across class and membership. Results: Access to treatment of lung cancer patients was 0.5 for outpatient care and 0.7 for inpatient care per 10,000 members. This prevalence was higher compared with the national reported prevalence of lung cancer which was 0.3 per 10,000 populations. However, access and utilization among poorer members (third class and PBI membership) were only 0.1 for outpatient and 0.2 for inpatient per 10,000 members. The quality of treatment mortality and self-discharges were 6.04% and 5.68% compared with the higher class of members which account for 0.48% and 2.31% in 2015. Conclusion: There were inequities in access, utilization, and clinical outcomes among lung cancer patients suggesting disparities of supplies side and nonfinancial barriers among lower socioeconomic groups. The authors suggest the national and local governments should accelerate to produce oncologists and subnational cancer centers to ensure access among NHIS members.