scholarly journals Changes in Determinants and Equity of Family Planning Utilization after the Implementation of a National Health Insurance Policy in Indonesia: A Secondary Analysis of The 2012-2016 National Socio-Economic Survey of Indonesia

2019 ◽  
Author(s):  
Siti Khadijah Nasution ◽  
Yodi Mahendradhata ◽  
Laksono Trisnantoro
Keyword(s):  
Health Insurance ◽  
Family Planning ◽  
National Health Insurance ◽  
National Health ◽  
Rural Areas ◽  
Urban Areas ◽  
National Level ◽  
Health System Improvement ◽  
System Improvement ◽  
Economic Survey

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. In 2016, the geography factor (rural-urban) and household economic status associated negatively with the use of overall contraceptive method (p<0.05). Conversely, all 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 increase through health system improvement, and the societal norms approach. Health system improvement is operationalized through improving supply-side and regulations, increasing coordination among multiple agencies in the family planning program. Keywords: Equity, National Health Insurance, Family Planning, Indonesia

scholarly journals Changes in Determinants and Equity of Family Planning Utilization after the Implementation of a National Health Insurance Policy in Indonesia: A Secondary Analysis of The 2012-2016 National Socio-Economic Survey of Indonesia

2020 ◽  
Author(s):  
Siti Khadijah Nasution ◽  
Yodi Mahendradhata ◽  
Laksono Trisnantoro
Keyword(s):  
Health Insurance ◽  
Family Planning ◽  
National Health Insurance ◽  
Rural Areas ◽  
Urban Areas ◽  
National Level ◽  
Insurance Policy ◽  
Health System Improvement ◽  
System Improvement ◽  
Economic Survey

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. In 2016, the geography factor (rural-urban) and household economic status associated negatively with the use of overall contraceptive methods (p<0.05). Conversely, all 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 increase through health system improvement, and the societal norms approach. Health system improvement is operationalized through improving supply-side and regulations, increasing coordination among multiple agencies in the family planning program.

scholarly journals Changes in Determinants and Equity of Family Planning Utilization after the Implementation of a National Health Insurance Policy in Indonesia: A Secondary Analysis of The 2012-2016 National Socio-Economic Survey of Indonesia

2019 ◽  
Author(s):  
Siti Khadijah Nasution ◽  
Yodi Mahendradhata ◽  
Laksono Trisnantoro
Keyword(s):  
Health Insurance ◽  
Family Planning ◽  
National Health Insurance ◽  
National Health ◽  
Rural Areas ◽  
Urban Areas ◽  
National Level ◽  
Secondary Analysis ◽  
Insurance Policy ◽  
Economic Survey

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.

scholarly journals Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia

2019 ◽  
Vol 32 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Siti Khadijah Nasution ◽  
Yodi Mahendradhata ◽  
Laksono Trisnantoro
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Economic Status ◽  
National Level ◽  
Secondary Analysis ◽  
Geographical Location ◽  
Skilled Birth Attendants ◽  
Birth Attendants ◽  
Economic Survey

The Indonesian government has been implementing the National Health Insurance ( Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation ( P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.

scholarly journals Evaluation of Midwifery Care Standard Policy BPJS Health Participants

2020 ◽  
Vol 7 (2) ◽  
pp. 172-184
Author(s):  
Astri Nurdiana ◽  
Ella Nurlailasari
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
Rural Areas ◽  
Urban Areas ◽  
Midwifery Care ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Standard Rate ◽  
Urban And Rural Areas

Enforcement of national health insurance organized through Badan Penyelenggara Jaminan Kesehatan (BPJS) experiences various polemics, one of which relates to financing for midwifery care listed in Permenkes No. 52 of 2016 concerning health service fare standards in the health insurance program, whether the standard rate can cover the needs of services provided by midwives in rural or urban areas or not. The result found that there is no difference in midwifery care fare between urban and rural areas (p>0.05), but there are differences in midwifery care fare between rural and BPJS fare standard (p<0.05) and between urban fare and BPJS fare standard (p< 0.05)

scholarly journals Evaluation of Community Perspectives on National Health Insurance Policy to Health Service Delivery in Ghana

2018 ◽  
Vol 29 (1) ◽  
pp. 3-18 ◽  
Author(s):  
Da Costa Aboagye ◽  
Jane South ◽  
Hafiz T. A. Khan
Keyword(s):  
Health Insurance ◽  
Focus Group ◽  
National Health Insurance ◽  
National Health ◽  
National Level ◽  
Health Service Delivery ◽  
Focus Group Discussions ◽  
Policy And Practice ◽  
Group Discussions ◽  
Medical Treatments

This article aims to examine the National Health Insurance Scheme (NHIS) policy from the perspective of local communities. Qualitative data from 9 key informant interviews and 72 community respondents in 9 focus group discussions were analyzed using a thematic network approach. The focus-group discussions took place in seven different communities in seven regions of Ghana. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results indicated lack of voice and understanding as the features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed, first, lack of stakeholder engagement and consultation or participation in the NHIS decision-making process. Second, it was established that while the policy indicated a will to include all the core poor for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, despite being a pro-poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the center undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. This article proposes that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding, and voices should be recognized to shape the future NHIS policy and practice.

scholarly journals Penganggaran dan Penerimaan Dana Kapitasi Program JKN di Daerah Terpencil Kabupaten Kepulauan Mentawai

2018 ◽  
pp. 92-101
Author(s):  
Desi Fitria Neti ◽  
Lukman Waris ◽  
Anni Yulianti
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
National Health Insurance ◽  
National Health ◽  
Rural Areas ◽  
Health Workers ◽  
National Health Insurance Program ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Right

Abstrak Program Jaminan Kesehatan Nasional (JKN) dilaksanakan atas hak setiap warga negara memperoleh layanan kesehatan, baik yang bertempat tinggal di perkotaan maupun di perdesaan termasuk di daerah terpencil perbatasan kepulauan. Pelaksana program JKN dilaksanakan oleh unit pelayanan kesehatan mulai dari pelayanan kesehatan di puskesmas sampai dengan pelayanan kesehatan rujukan di rumah sakit dengan pembayaran yang dilakukan oleh Badan Pelaksana Jaminan Sosial Kesehatan (BPJS) kepada unit pelaksana pelayanan kesehatan dengan mekanisme transfer berdasarkan sistem dana kapitasi. Penelitian ini bertujuan untuk mendeskripsikan dan menganalisis pelaksanaan penganggaran dan penerimaan dana kapitasi tenaga kesehatan program jaminan kesehatan nasional di daerah terpencil Puskesmas Mapaddegat Kabupaten Kepulauan Mentawai dengan mengunakan metode kualitatif. Pengumpulan informasi melalui observasi wawancara mendalam terhadap informan dan informan kunci dan Dokumentasi. Penelitian dilaksanakan bulan januari s/d juni 2017. Hasil penelitian menggambarkan bahwa pelaksanaan penganggaran dan penerima dana kapitasi tenaga kesehatan pada tahun 2014-2015 belum berjalan sesuai ketentuan pembayaran, tahun 2016 masih ditemukan permasalahan pembayaran norma kapitasi oleh BPJS Kesehatan sudah normatif namun belum sesuai dengan jumlah peserta yang terdaftar. Tahun 2017 penerimaan dana kapitasi sudah berjalan lebih baik dibuktikan dengan telah teradministrasi dan terdokumentasi semua bentuk pemanfaatan dan realisasi belanja pencairan dana kapitasi untuk seluruh petugas di puskesmas dan jaringannya. Kata kunci: Tenaga kesehatan, penganggaran, penerimaan dana kapitasi dan program JKN. Abstract The National Health Insurance Program (JKN) is implemented on the right of every citizen to receive health services in both urban and rural areas, including in remote border areas of the island. Implementing the JKN program is implemented by health care unit starting from health service at puskesmas to referral health service in hospital with payment made by BPJS to health service implementation unit with transfer mechanism based on capitation fund system. This study aims to describe and analyze the implementation of budgeting and receiving capitation funds health workers national health insurance program in remote areas Mapaddegat Puskesmas Mentawai Islands by using qualitative methods. Information gathering through in-depth interview observation of key informants and informants and Documentation. The study was conducted from January to June 2017. The results of this study illustrate that the implementation of budgeting and recipients of capitation funds of health personnel in 2014-2015 has not run according to payment terms, in 2016 still found the problem of payment of capitation norms by BPJS Health has been normative but not in accordance with number of registered participants according to the provisions. In 2017, the capitation of the capitation funds has been better implemented as proven by the administration and documentation of all forms of utilization and realization of capitation fund disbursement expenditure for all officers at the puskesmas and its network. Keywords: Health Manpower, policy, budgeting, admission of capitation funds and Health Insurance Program.

scholarly journals Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana

2018 ◽  
Vol 3 (1) ◽  
pp. e000590 ◽  
Author(s):  
Nele van der Wielen ◽  
Andrew Amos Channon ◽  
Jane Falkingham
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Rural Areas ◽  
Outpatient Care ◽  
National Health Insurance Scheme ◽  
Healthcare Utilisation ◽  
Insurance Scheme ◽  
Inpatient And Outpatient Care

IntroductionThis paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed.MethodsUsing the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over.ResultsThe raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled.ConclusionThe results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.

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