ACADSTAFF UGM

CREATION
Title : Impact of Indonesia’s national health insurance scheme on inequality in access to maternal health services: A propensity score matched analysis
Author :

Kanya Anindya (1) John Tayu Lee (2) Barbara McPake (3) Prof. dr. Siswanto Agus Wilopo, SU, M.Sc, Sc.D (4) Christopher Millett (5) Natalie Carvalho (6)
Date : 11 2020
Keyword : Indonesia’s national health insurance scheme , maternal health services Indonesia’s national health insurance scheme , maternal health services
Abstract : Background: Reducing inequality in maternal, neonatal and infant mortality are key targets in the Sustainable Development Goals. This study is the first to evaluate the impact of Indonesia's national health insurance scheme, Jaminan Kesehatan Nasional (JKN), on access to maternal health services by sociodemographic status. Methods: Using data from the 2017 Indonesia Demographic and Health Survey (IDHS) on women with live births in 2016-2017, we conducted propensity score matching (PSM) analysis to evaluate the association of JKN enrollment on the following maternal health care utilisation outcomes: (1) at least four antenatal care (ANC4+) visits; (2) ANC4+ visits and received essential components of ANC; (3) skilled birth attendance; (4) facility-based delivery; (5) post-natal care (PNC); and (6) PNC with skilled provider. Analyses were conducted at the national level and by economic subgroup and region of residence. Additionally, we investigated the potential negative impact of JKN on access to maternal health services among the uninsured population by looking at trends over time using data from the 2012 and 2017 IDHS. Results: Of the 5429 women who had recently given birth, 61% were insured by JKN in 2017. After matching treated and untreated women on key sociodemographic characteristics, enrollment in JKN was associated with a higher prevalence of receiving ANC4+ visits (7.4%, 95% confidence interval (CI) = 4.8-9.39); ANC4+ visits and received essential components of ANC (5.6%, 95% CI = 3.3-7.9); skilled birth attendance (3.0%, 95% CI = 1.5-4.5; facility-based delivery (10.2%, 95% CI = 7.5-12.7); PNC (4.0%, 95% CI = 2.2-5.7); PNC with skilled provider (4.5%, 95% CI = 2.6-6.5). Effect sizes were larger among the poor and those living in less-developed areas, such as Eastern Indonesia and Sulawesi, except for at least ANC4+ and received clinical components. Conclusions: Expansion of health insurance coverage was associated with reductions in sociodemographic inequalities in access to maternal health services in Indonesia. However, large differences in utilisation persist across regions and by economic subgroup. Accelerating progress toward universal health coverage may reduce health inequalities in other low and middle-income countries.
Group of Knowledge : Kesehatan Masyarakat
Original Language : English
Level : Internasional
Status :
Published
Document
No Title Document Type Action
1 JOGH-10-010429.pdf
Document Type : [PAK] Full Dokumen
[PAK] Full Dokumen View
2 Impact of Indonesia’s national health insurance scheme on inequality in access to maternal health services_ Similarity.pdf
Document Type : [PAK] Cek Similarity
[PAK] Cek Similarity View
3 Impact of Indonesia’s national health insurance scheme on inequality in access to maternal health services_ A propensity score matched analysis (1).pdf
Document Type : [PAK] Cek Similarity
[PAK] Cek Similarity View