Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN)

Ekawati, Fitriana Murriya; Claramita, Mora

doi:10.1177/21501327211023707

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…In theory, JKN members should not incur OOP payments when they visit health facilities within the JKN network. But there is evidence that the cost of medical procedures is often higher than the capitation payment and INA-CBG tariffs [ 24 , 25 ]. As a result, households may still face the burden of OOP health payments even if they are insured under the JKN.…”

Section: Discussionmentioning

confidence: 99%

Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019

Fattah,

Cheng,

Thabrany

et al. 2023

Int J Equity Health

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Background Indonesia implemented one of the world’s largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. Methods This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February–April 2018 and August–October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. Results The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. Conclusions This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.

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Section: Discussionmentioning

confidence: 99%

Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019

Fattah,

Cheng,

Thabrany

et al. 2023

Int J Equity Health

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“…31 The views and experiences of Indonesian general practitioners practicing in primary care in implementing NHI show that although NHI improves patient access to health services, many general practitioners in Indonesia experience challenging practices, limited clinical resources, and extensive administration in primary care. 32,33 Meanwhile, this study informs two variables related to residence and utilization of primary health services in the Papua region, Indonesia: province and type of residence. According to Statistics data in 2017, about 79.68 percent of villages in the Papua region are located in mountainous areas.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018

Laksono¹,

Nugraheni²,

Ipa³

et al. 2022

International Journal of Social Determinants of Health and Heal

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Health development in the Papua region often lags behind other areas of Indonesia. The study aims to analyze the role of government-run insurance in primary health care utilization in the Papua region, Indonesia. The study examined 17,879 Papuan. The study used primary health care utilization as an outcome variable and health insurance ownership as an exposure variable. The study also employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and travel time to primary health care. The research employed data using binary logistic regression in the final analysis. The results show that Papuans with government-run insurance were three times more likely to utilize primary health care than uninsured Papuans (AOR 3.081; 95% CI 3.026–3.137). Meanwhile, Papuan with private-run insurance were 0.133 times less likely to utilize primary health care than uninsured Papuans (AOR 0.133; 95% CI 0.109–0.164). Moreover, Papuans who have two types of health insurances (government-run and private-run) were 1.5 times more likely to utilize the primary health care than uninsured Papuan (AOR 1.513; 95% CI 1.393–1.644). The study concluded that government-run insurance increases the chance of primary health care utilization in the Papua region, Indonesia. Government-run insurance has the most prominent role compared to other health insurance categories.

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“…Our workshops and interviews were also always using open ended questions, including our prompts in the email and the WhatsApp groups to allow views from the participants. We also noted any non-verbal intonation or gestures from the participants during the workshops/interviews [ 40 – 42 ], and preserved authenticity by purposefully selecting participants and allowing them to freely articulate their needs. To achieve the participants’ validation, we circulated the summary and notes of each workshop using email and WhatsApp group communication.…”

Section: Methodsmentioning

confidence: 99%

Adopting international recommendations to design a model for maternal health service to cope with pandemic disruption for Indonesian primary care

Ekawati

Muchlis

Tuteja

2023

BMC Pregnancy Childbirth

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Background Limited evidence is available as the reference for the model of care on providing maternity care in low-and-middle-income countries (LMICs) to cope with pandemic disruption. This study aimed to adopt international recommendations to develop the model of care with the context of Indonesian settings. Methods Four codesign workshops and substitute interviews with stakeholders, covering the (i) exploration of service provision during the pandemic, (ii) adoption of international recommendations, (iii) designing and (iv) finalising model of care for maternal health services in primary care under the COVID-19 pandemic. The study took place in Yogyakarta Province Indonesia from July-November 2021. The participants were general practitioners, midwives, nurses, patients, and obstetricians. The data were analysed thematically. Results Twenty-three participants were recruited. As many as 23, 16, 14 and 16 participants participated in the first to fourth codesign workshops or substitute interviews. Key recommendations agreed upon in the workshop were health screening, maintaining antenatal-postnatal breastfeeding care, limiting visitors, using telemedicine, and creating a multidisciplinary team to provide the care. A model of care for improving maternal service was also agreed and received suggestions from the participants. Identified barriers to the recommendation implementation, such as the available clinical resources and negotiating providers’ authority in practice. Conclusion Recommendations and the model of care for improving maternity care in Indonesia are beneficial to be implemented in Indonesian primary care during the COVID-19 pandemic. Further research includes pilot studies to explore the acceptability of the model and recommendation implementation in practice.

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Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN)

Cited by 11 publications

References 28 publications

Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019

Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018–2019

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018

Adopting international recommendations to design a model for maternal health service to cope with pandemic disruption for Indonesian primary care

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