The Impact of Health Insurance on Maternal Health Care in Indonesia: A Systematic Review

Abstract

Background Indonesia still has the highest maternal mortality rate (MMR) compared to other countries in Southeast Asia. In Indonesia, most maternal deaths occur before, during, or after delivery. Therefore, Indonesia’s government has rolled out various health insurance schemes so they have access to maternal healthcare services. This review aims to evaluate the impact of health insurance on maternal health care in Indonesia.Methods All searches for relevant studies were performed in PubMed, Science Direct, Cochrane, and Garuda databases. This review focuses on RCT or observational study, and only articles written in English and Indonesian were retrieved. The main outcome was the utilization of maternal services and patient satisfaction.Results A total of 140,555 participants were enrolled with ten studies that met the inclusion criteria. Of these, seven studies reported on National Health Insurance (NHI) and the remaining reported on Local Health Insurance (LHI). Both NHI and LHI studies showed that insurance increases the use of maternal health care services significantly, including antenatal, delivery, and postnatal care services. Only two studies reported patient satisfaction. The LHI study showed that insurance increases the patient’s level of satisfaction significantly. On the other hand, the NHI study showed there is no difference between NHI and non-NHI patients’ levels of satisfaction. This was due to complicated procedures and long examination times for NHI users.Conclusion The implementation of health insurance appears to increase the utilization of maternal health care services, although the result on patients’ satisfaction is inconsistent between NHI and LHI studies.

Appraisal of universal health insurance and maternal health services utilization: pre- and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia

“…However, most of these studies relied on single-year cross-sectional data to investigate the influence of health insurance coverage on maternal health service utilization, rather than emphasizing the assessment of pre- and post-policy effects on care. Furthermore, there was a lack of information regarding the existence of variations in the utilization and readiness of maternal health services across different regions within Indonesia ( 14 , 18 ).…”