Inequality in access to health care, health insurance and the role of supply factors

Johar, Meliyanni; Soewondo, Prastuti; Pujisubekti, Retno; Satrio, Harsa Kunthara; Adji, Ardi

doi:10.1016/j.socscimed.2018.07.044

Cited by 79 publications

(73 citation statements)

References 17 publications

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“…Women who do not have health insurance have lower ANC utilization. This finding is in line with the goal of the National Health Insurance released by the Indonesian government to provide universal access to health care facilities [49,50]. Social insurance policies to increase public access to health care facilities have also been adopted by other countries.…”

Section: Discussionsupporting

confidence: 77%

Regional Disparities of Antenatal Care Utilization in Indonesia

Laksono

Rukmini

Wulandari

2019

Preprint

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Introduction:The main strategy for decreasing maternal morbidity and mortality with antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote healthy living behavior. The study aims to analyze inter-regional disparities in ≥4 ANC visits during pregnancy in Indonesia. Methods: Data sources from 2017 Indonesian Demographic and Health Survey (IDHS). With an analysis unit of women aged 15-49 years old, a sample of 15,351 women was obtained. Besides 2 ANC as the dependent variable, other variables analyzed were place of residence, age, husband/partner, education, parity, wealth status, and health insurance. Analysis using Binary Logistic Regression for the final test to determine disparity. Results: All regions show a gap with the Papua region as a reference, except the Maluku region which was not significant shows differences in the use of ANC compared to the Papua. Women in the Nusa Tenggara have 4,365 chances of making ≥4 ANC visits compared to the Papua region.Women in Java-Bali have 3,607 times more chances to make ≥4 ANC visits than women in the Papua region. Women in Sumatra have 1,370 chances of making ≥4 ANC visits compared to women in the Papua region. Women in Kalimantan have 2.232 times made ≥4 ANC visits compared to women in the Papua region. Women in Sulawesi have 1,980 times more than AN4ANC visits compared to women in the Papua region. In addition to the region category, other variables found to contribute to the predictor were age, husband/partner, education, parity, wealth and insurance.Conclusion: There were disparities between regions in the ANC utilization in Indonesia.Keyword: antenatal care, the barrier of utilization, mother health

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Section: Discussionsupporting

confidence: 77%

Regional Disparities of Antenatal Care Utilization in Indonesia

Laksono

Rukmini

Wulandari

2019

Preprint

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“…The study on the effect of insurance usage have often been conducted. The results of the study showed a positive correlation (El-Sayed, Vail and Kruk, 2018;Johar et al, 2018;Lee et al, 2018). Note: (a) The reference category was "no utilization"; (b) Floating point overflow occurred while computing this statistic.…”

Section: Resultsmentioning

confidence: 83%

Urban-Rural Disparities in The Utilization of Primary Health Care Center Among Elderly in East Java, Indonesia

Wulandari¹,

Laksono²

2019

Preprint

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Introduction: Urban always attracts investors to invest. Health facilities in urban areas are growing rapidly compared to villages. This condition is estimated to contribute to the disparity of urban-rural areas in the utilization of health services. Studying the utilization of health services is a way to evaluate the performance of the health care system through its output. Aim: This study was intended to analyze urban-rural disparity in the utilization of primary health care or puskesmas use by the elderly.Methods: This study was used the 2013 Riskesdas (Indonesian Basic Health Survey) raw data. The 2013 Riskesdas was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 25,813 elderly people in East Java Province were obtained. Data were analyzed using Multinomial Logistic Regression tests.Results: Elderly people in urban areas have a better probability of outpatient use of 1.208 than those living in rural areas (OR 1.208; 95% CI 1.057-1.380). The elderly who have a primary school and under education have the possibility of 1.558 times more utilizing outpatients in the puskesmas than the elderly who have college education levels (OR 1.558; 95% CI 1.001-2.424). Conclusions: There was a disparity between urban and rural areas in the utilization of outpatient puskesmas in East Java by the elderly. Policy makers in East Java are recommended to improve facilities and infrastructure of the puskesmas in rural areas by paying attention to the results of this study.

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“…The private sector prefers to participate in development in urban areas. This is because of the denser population density, so it is more profitable economically [29][30] [31]. The government must be able to respond to this condition, it needs ongoing evaluation to ensure efforts to minimize the disparity between the two regions, and ensure better access in rural areas [5][32] [33].…”

Section: Discussionmentioning

confidence: 99%

Urban–Rural Disparities of Facility-Based Childbirth in Indonesia

Laksono¹,

Wulandari²

2020

Proceedings of the 4th International Symposium on Health Research (ISHR 2019)

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Equitable distribution of health services between areas is still a problem in various countries. Even in developed countries. This condition also applies to the utilization of healthcare facilities for childbirth. To analyze the urban-rural disparities of facilities-based childbirth in Indonesia. The analysis in this study uses raw data from the 2017 IDHS. With stratification and multistage random sampling, 17,769 women aged 15-49 years with live births in the last 5 years were sampled. Data were analyzed using a Binary Logistic Regression test. Women in urban areas were probably 2.417 times more utilizing healthcare facilities for delivery than those in rural areas. Women with tertiary education were likely to be 1.709 times more utilizing healthcare facilities for delivery than those who don't. Richest women were probably 6.556 times more utilizing healthcare facilities for delivery than poorest women. Women who have health insurance maybe 1.437 times more utilizing healthcare for delivery than women who don't have. Women who know about the danger signs of pregnancy are more than 1.514 times more likely to utilize healthcare for delivery than those who don't know. Women who do ANC ≥ 4 times have the possibility of 1.729 times using healthcare facilities compared to those who do ANC less than 4. There were significant differences between women in urban and rural areas in utilizing healthcare facilities for delivery. Women who live in urban areas have a better chance to utilize healthcare facilities for delivery. The government needs to focus on women with low education and poor status. Interventions were needed by socializing the danger signs of pregnancy in rural areas. In addition, it was also necessary to expand the scope of membership of the National Health Insurance in rural areas.

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Inequality in access to health care, health insurance and the role of supply factors

Cited by 79 publications

References 17 publications

Regional Disparities of Antenatal Care Utilization in Indonesia

Regional Disparities of Antenatal Care Utilization in Indonesia

Urban-Rural Disparities in The Utilization of Primary Health Care Center Among Elderly in East Java, Indonesia

Urban–Rural Disparities of Facility-Based Childbirth in Indonesia

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