A Study of Ability to Pay and Willingness to Pay of National Health Insurance Voluntaryparticipant in Rural Area

Intiasari, Arih Diyaning; Aji, Budi; Masfiah, Siti; Trisnantoro, Laksono; Hendrartini, Julita

doi:10.36295/asro.2019.221124

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…However, BPJS data were not suitable for the evaluation of determinants for PHC acceptance. Indonesia still has other problems that affect the implementation of JKN, such as the historically determined culture of poor people seeking healthcare differing from that of average urban people ( 29 , 30 ). Overall, HRH availability and sufficient qualification will likely remain a challenge in the upcoming years due to persistent limitations in infrastructure related to economic opportunities ( 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

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

Wenang

Schaefers

Afdal³

et al. 2021

Front. Public Health

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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.

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Section: Discussionmentioning

confidence: 99%

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

Wenang

Schaefers

Afdal³

et al. 2021

Front. Public Health

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Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis

Bayked,

Assfaw,

Toleha

et al. 2024

Front. Public Health

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BackgroundUniversal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia.MethodsDatabase searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute’s (JBI’s) tools and the “preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement” were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI.ResultsNineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0–77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68–75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it.ConclusionThe WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

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A Study of Ability to Pay and Willingness to Pay of National Health Insurance Voluntaryparticipant in Rural Area

Cited by 2 publications

References 6 publications

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

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

Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis

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