Predictors of national health insurance membership among the poor with different education levels in Indonesia

Abstract

Background Indonesia has made significant progress in expanding universal health coverage (UHC) through its National Health Insurance (NHI) mechanism. However, in the context of NHI implementation in Indonesia, socioeconomic disparities caused its subpopulations to have different literacy of NHI concepts and procedures, increasing the risk of healthcare access inequities. Hence, the study aimed to analyse the predictors of NHI membership among the poor with different education levels in Indonesia. Methods This study used the secondary dataset of the nationwide survey “Abilities and Willingness to Pay, Fee, and Participant Satisfaction in implementing National Health Insurance in Indonesia in 2019” by The Ministry of Health of the Republic of Indonesia. The study population was the poor population in Indonesia and included a weighted sample of 18,514 poor people. The study used NHI membership as a dependent variable. Meanwhile, the study analysed seven independent variables: wealth, residence, age, gender, education, employment, and marital status. In the final step of the analysis, the study used binary logistic regression. Results The results show that the NHI membership among the poor population tends to be higher among those who have higher education, live in urban areas, are older than 17 years old, are married and are wealthier. The poor population with higher education levels is more likely to become NHI members than those with lower education. Their residence, age, gender, employment, marital status, and wealth also predicted their NHI membership. Poor people with primary education are 1.454 times more likely to be NHI members than those without education (AOR 1.454; 95% CI 1.331–1.588). Meanwhile, those with secondary education are 1.478 times more likely to be NHI members than those with no education (AOR 1.478; 95% CI 1.309–1.668). Moreover, higher education is 1.724 times more likely to result in being an NHI member than no education (AOR 1.724; 95% CI 1.356–2.192). Conclusion Education level, residence, age, gender, employment, marital status, and wealth predict NHI membership among the poor population. Since significant differences exist in all of those predictors among the poor population with different education levels, our findings highlighted the importance of government investment in NHI, which must be supported with investment in the poor population’s education.

Role of Socioeconomic Status in National Health Insurance Ownership in Indonesia’s Rural Areas

“… 6 The reason is uncertain income, considering that most lower-middle-class people work in the informal sector. 7 , 8 …”

“…The program aims to fulfill the basic needs of the community in the health sector to protect the community. 8 In this program, all people are required to become NHI participants. By participating, it is hoped that the community will be protected and get health service guarantees.…”

“…6 The reason is uncertain income, considering that most lower-middle-class people work in the informal sector. 7,8 On the other hand, wealth status can increase the likelihood of enrolling in a national health insurance (NHI) scheme. 9 A systematic review of 48 articles from 17 lower-middle-income countries showed that households from the wealthiest group had greater odds of applying for health insurance than the poorest group.…”

Availability and quality of primary health care in the compulsory health insurance system in Kazakhstan

“…6 The study found that the educational attainment of the poor in uences the decision to become members of the National Insurance Scheme than those with less or no education. 7 In order to control and improve the e ciency of insurers' data management, a uni ed information system in healthcare organizations is important, which should expand cooperation with the medical industry to further develop the application processes of big healthcare data and eliminate privacy risks. 8 There are problems in the CIS countries that hinder the coverage of the population with compulsory health insurance.…”

Comparison Of Patient Satisfaction Levels Between The Use Of National Health Insurance (Nhi) And Private Health Insurance (Phi) In Hospital Financing: A Systematic Review And Meta-Analysis

“…(Febriyanti et al, 2023) In Indonesia, despite setting a goal of 95% membership coverage by the end of 2019, NHI only managed to reach 85.3%. (Putri et al, 2023) However, in practice, health services in hospitals often become a public issue because of the perceived differences they receive, which can impact patient satisfaction. Since the public still sees the system favorably, interest in NHI services is typically minimal.…”