scholarly journals Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia

2021 ◽  
Vol 9 ◽  
Author(s):  
Supriyatiningsih Wenang ◽  
Juergen Schaefers ◽  
Andi Afdal ◽  
Ali Gufron ◽  
Siegfried Geyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Human Resources ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
The Poor ◽  
Highly Correlated ◽  
Referral Behavior ◽  
Universal Health ◽  
Poor Population

Background: Adopting Universal Health Coverage for implementation of a national health insurance system [Jaminan Kesehatan Nasional (JKN)/Badan Penyelenggara Jaminan Sosial or the Indonesian National Social Health Insurance Scheme (BPJS)] targets the 255 million population of Indonesia. The availability, accessibility, and acceptance of healthcare services are the most important challenges during implementation. Referral behavior and the utilization of primary care structures for underserved (rural/remote regions) populations are key guiding elements. In this study, we provided the first assessment of BPJS implementation and its resulting implications for healthcare delivery based on the entire insurance dataset for the initial period of implementation, specifically focusing on poor and remote populations.Methods: Demographic, economic, and healthcare infrastructure information was obtained from public resources. Data about the JKN membership structure, performance information, and reimbursement were provided by the BPJS national head office. For analysis, an ANOVA was used to compare reimbursement indexes for primary healthcare (PHC) and advanced healthcare (AHC). The usage of primary care resources was analyzed by comparing clustered provinces and utilization indices differentiating poor [Penerima Bantuan Iur (PBI) membership] and non-poor populations (non-PBI). Factorial and canonical discrimination analyses were applied to identify the determinants of PHC structures.Results: Remote regions cover 27.8% of districts/municipalities. The distribution of the poor population and PBI members were highly correlated (r2 > 0.8; p < 0.001). Three clusters of provinces [remote high-poor (N = 13), remote low-poor (N = 15), non-remote (N = 5)] were identified. A discrimination analysis enabled the >82% correct cluster classification of infrastructure and human resources of health (HRH)-related factors. Standardized HRH (nurses and general practitioners [GP]) availability showed significant differences between clusters (p < 0.01), whereas the availability of hospital beds was weakly correlated. The usage of PHC was ~2-fold of AHC, while non-PBI members utilized AHC 4- to 5-fold more frequently than PBI members. Referral indices (r2 = 0.94; p < 0.001) for PBI, non-PBI, and AHC utilization rates (r2 = 0.53; p < 0.001) were highly correlated.Conclusion: Human resources of health availability were intensively related to the extent of the remote population but not the numbers of the poor population. The access points of PHC were mainly used by the poor population and in remote regions, whereas other population groups (non-PBI and non-Remote) preferred direct access to AHC. Guiding referral and the utilization of primary care will be key success factors for the effective and efficient usage of available healthcare infrastructures and the achievement of universal health coverage in Indonesia. The short-term development of JKN was recommended, with a focus on guiding referral behavior, especially in remote regions and for non-PBI members.

scholarly journals Gambaran Out of Pocket pada Awal Era JKN di Indonesia

2018 ◽  
pp. 141-146
Author(s):  
Ingan Tarigan ◽  
Taty Suryati
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Financial Protection ◽  
Health Coverage ◽  
Medical Expenses ◽  
The Poor ◽  
The Government ◽  
Universal Health

Abstrak Pogram Jaminan Kesehatan Nasional (JKN) salah satunya bertujuan memberikan perlindungan finansial khususnya biaya katastropik terhadap semua peserta. Penerima manfaat JKN berhak mendapatkan berbagai layanan sebagai bagian dari paket manfaat dasar tanpa mengeluarkan biaya pelayanan, dan diharapkan Out of Pocket (OOP) akan lebih rendah dibandingkan dengan mereka yang tidak memiliki asuransi kesehatan. Tujuan penulisan akan membandingkan total pengeluaran untuk kesehatan dari peserta jaminan kesehatan dengan yang tidak memiliki jaminan kesehatan pada awal era JKN. Dalam analisis ini, pengukuran pengeluaran perawatan kesehatan hanya mencakup biaya pengobatan langsung, seperti biaya konsultasi, pemakaian kamar di rumah sakit dan obat-obatan. Analisis dengan menggunakan data Susenas 2014 terdiri dari 274.673 individu dan 71.051 rumah tangga di 33 provinsi di Indonesia. Hasil penelitian menunjukkan bahwa pada awal era JKN ada sedikit perbedaan OOP pada penduduk miskin dibandingkan dengan penduduk dimana proteksi finansial terhadap penduduk miskin untuk pengeluaran kesehatan masih rendah.Kepemilikan jaminan kesehatan memberikan proteksi finansial akibat pengeluaran biaya kesehatan, khususnya pengeluaran biaya katastropik dibandingkan dengan yang tidak memiliki jaminan kesehatan. Kepesertaan penduduk miskin ditargetkan tahun 2019 sudah terpenuhi sehingga target pemerintah tentang Universal Health Coverage (UHC) perlindungan finansial pada penduduk miskin dan hampir miskin semakin tinggi atau OOP semakin mendekati nol. Kata kunci: OOP, Pembiayaan, Asuransi Kesehatan Abstract One of the main objectives of the JKN program is to provide financial protection, especially catastrophic costs to all members. JKN beneficiaries are entitled to various services as part of the basic benefit package without incurring service costs, and it is expected that Out of Pocket (OOP) will be lower than those who do not have health insurance. The purpose of writing will be to compare the total health expenditures of health insurance participants or beneficiaries and those without health insurance. In this analysis, the measurement of health care expenditures only includes direct medical expenses, such as consultation fees, hospital room usage and medication. Using Susenas data 2014 consists of 274,673 individuals and 71,051 households in 33 provinces in Indonesia. At the beginning of the JKN implementation, there was little difference of out of pocket in the poorest population compared to the richest population. This shows that financial protection to the poor for health expenditures are still low. The ownership of health insurance tends to provide financial protection due to health expenditures, especially catastrophic expenses compared to those without health insurance. In the Year of 2019 where the government targeted to Universal Health Coverage (UHC) expected protection financial on the poor and near poor is getting higher or out of pocket or getting closer up to zero. Keywords: OOP, Financial Protection, Health Insurance

scholarly journals Kebijakan Pembiayaan Kesehatan terhadap Masyarakat Miskin dalam Pencapaian Universal Health Coverage di Kabupaten Banjar

2020 ◽  
Vol 15 (2) ◽  
pp. 219-229
Author(s):  
Annida
Keyword(s):  
Health Insurance ◽  
Data Collection ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Poor People ◽  
Health Coverage ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
The Poor ◽  
Universal Health

Achievement of Universal Health Coverage (UHC) is achieved through the participation of JKN - Health BPJS by all Indonesians. Not all poor people were the premium assistance beneficiary, while since 2020 regional health insurance was abolished. The study aims to determine the UHC achievements of the governments, particularly in health financing for the poor. This research uses an Analytic-qualitative approach with the cross-sectional method and was conducted in 2019. Data collection through in-depth interviews with purposive sampling at the Regional Public Health Office, Regional Planning and Development Office, and Social Service in Banjar Regency. The stages for Analysis consist of data reduction, presentation, and data collection. Banjar Regency government involves CSR at TKPKD forum to cover health financing for the poor and underprivileged outside the premium assistance beneficiary, but there were gaps in the unified database synchronization, which can be an obstacle in projecting the health financing and budgeting. The government needs to increase the premium assistance beneficiary quota. The mid-income people or people who can afford health insurance should join the independent universal healthcare participants, so that premium assistance beneficiary is designated only for the poor. Coordination across sectors and programs must be integrated into SLRT. Keywords: Financial Policy, Health Financing, Universal Health Coverage, JKN-BPJS. ABSTRAK Pencapaian Universal Health Coverage (UHC) diwujudkan melalui kepesertaan pada JKN-BPJS Kesehatan oleh seluruh rakyat Indonesia, tanpa terkecuali. Masyarakat miskin dan tidak mampu yang didaftarkan oleh pemerintah daerah berdasarkan Basis Data Terpadu (BDT), dibayarkan oleh pemerintah daerah sebagai peserta Penerima Bantuan Iuran (PBI). Namun tidak semua masyarakat miskin dan tidak mampu masuk dalam daftar PBI. Disamping itu, di tahun 2020 kebijakan jaminan kesehatan daerah (Jamkesda) telah dihapus, sehingga masyarakat miskin bukan PBI tidak dapat lagi memperoleh bantuan pembiayaan kesehatan dari pemerintah. Penelitian ini dilakukan di Kabupaten Banjar untuk mengetahui langkah yang diambil oleh pemerintah daerah dalam menuju pencapaian UHC, yang diutamakan pada kebijakan pembiayaan kesehatan terhadap masyarakat miskin dan tidak mampu. Penelitian ini bersifat analitik dengan desain cross sectional, dilaksanakan pada pertengahan tahun 2019. Metode penelitian secara kualitatif. Pengumpulan data secara indepth interview. Informan penelitian adalah pemerintah daerah yang ditentukan secara purposive sampling, dari Dinas Kesehatan Kabupaten Banjar, Bappeda Kabupaten Banjar, dan Dinas Sosial Kabupaten Banjar. Analisis data dilakukan secara deskriptif dengan tahapan reduksi data, penyajian data dan penarikan kesimpulan. Kabupaten Banjar melalui forum Tim Koordinasi Penanggulangan Kemiskinan Daerah (TKPKD)  telah mewacanakan keterlibatan Corporate System Responsibility (CSR) dalam pembiayaan kesehatan masyarakat miskin dan tidak mampu yang berada diluar BDT atau bukan PBI, meskipun diperkirakan belum dapat membiayai masyarakat miskin secara keseluruhan. Namun masih terjadi permasalahan dalam sinkronisasi BDT masyarakat yang tergolong miskin dan tidak mampu tersebut yang dapat menjadi hambatan bagi Dinas Kesehatan dalam memperhitungkan anggaran pembiayaan kesehatan tersebut. Perlu diwacanakan penambahan kuota alokasi anggaran PBI sebagai salah satu solusi untuk dilaksanakan oleh pemerintah daerah. Disisi lain, masyarakat yang telah mampu secara ekonomi harus didorong untuk menjadi peserta BPJS mandiri, sehingga pembiayaan mereka yang semula PBI dapat dialihkan pada masyarakat miskin, diluar peserta PBI. Koordinasi lintas sektor maupun lintas program terintegrasi dalam SLRT, antara lain Dinas Kesehatan, Dinas Sosial, Dinas Kependudukan dan Catatan Sipil, dan Bappeda sehingga masyarakat miskin dan tidak mampu mendapatkan hak yang sama dalam memperoleh kesehatan. Rekomendasi dan strategi yang dilakukan oleh Kabupaten Banjar ini dapat diimplementasikan pada kabupaten/kota dengan kondisi dan permasalahan yang sama. Kata Kunci: Kebijakan Finansial, Pembiayaan Kesehatan, JKN-BPJS

scholarly journals Progressive Pathway to Universal Health Coverage in Tanzania: A Call for Preferential Resource Allocation Targeting the Poor

2018 ◽  
Vol 4 (4) ◽  
pp. 279-283
Author(s):  
Huihui Wang ◽  
Mariam Ally Juma ◽  
Nicolas Rosemberg ◽  
Mpoki M. Ulisubisya
Keyword(s):  
Resource Allocation ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
The Poor ◽  
Universal Health

scholarly journals An Analysis of The National Health Insurance Policy Implementation in 2014 (Presidential Regulation No. 12 And 111/2013 on Health Insurance) from The Regulator’s Position

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Muhammad Arief Hasan ◽  
Puput Oktamianti ◽  
Dumilah Ayuningtyas
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Regional Government ◽  
Health Coverage ◽  
Healthcare Facilities ◽  
Road Map ◽  
Universal Health

Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage

scholarly journals Narrowing the Gap of Inequity in the Indonesia’s National Social Health Insurance Scheme, 2014-2018

2021 ◽  
Author(s):  
Hasbullah Thabrany ◽  
Ryan R. Nugraha ◽  
Ery Setiawan ◽  
Farah Purwaningrum
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
Universal Health Coverage ◽  
Low Income ◽  
National Health Insurance Scheme ◽  
Income Group ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

Abstract Background. Indonesia is nearing its 7-year implementation of its national health insurance scheme, or the Jaminan Kesehatan Nasional (JKN), as a facilitator for achieving universal health coverage (UHC). Despite its long-running system, it is contentious as to whether JKN has been narrowing the gap of inequity in its delivery. This paper aims to explore on whether the national health insurance scheme in Indonesia have been promoting equity of access towards health services.Methods. This study analyzes findings from JKN statistic data of 2014-2018 published by Government of Indonesia. Using a retrospective design, this study identified membership and utilization of health services within JKN, based on different membership enrollment groups as proxy for income.Results. JKN has been expanding its enrollment significantly within 5 years, during year 2014 to 2018. Moreover, the study concludes that there was increased access for outpatient in all membership groups. Inpatient care was increased in low-income group, but not in high-income group. Result also showed inpatient access was correlated with adequate supply side intervention, particularly hospital beds.Conclusion. JKN has been successful in narrowing the inequity gap, particularly by serving the low-income group better in terms of access. Going forward, equity needs to be incorporated into JKN achievement indicator, particularly to accelerate Indonesia’s effort to realize universal health coverage.

Sign in / Sign up

Export Citation Format

Share Document