Who Experience Out-of-Pocket Expenditures for Modern Contraceptive Use in Indonesian Universal Health Coverage System?

Abstract

Integration of family planning programs into the universal health coverage system is expected to improve access toreproductive health services. All people should have access to sufficient and qualified family planning services they need without financial hardship. This study aimed to examine out-of-pocket expenditures of contraceptive services and the associated factors among fertile age couples that influence their access to modern contraceptive services.It was quantitative research with a cross-sectional design. Data obtained from the Health and Demographic Surveillance System 2016 of Sleman Regency, Indonesia, were analyzed using multiple logistic regression to determine factors associated with out-of-pocket expenditures for contraceptive services. This study revealed that more than 70% of people should pay for contraceptive services even though they had registered as health insurance members. Public non-subsidized and private health insurance members were more likely to experience OOP expenditures than public-subsidized participants (AOR=3.12; 95%CI=2.25-4.30 and AOR=3.47; 95%CI=1.60-7.52, respectively). Short-term contraception users were more likely to experience out-of-pocket expenditures thanlong-term users(AOR=6.38; 95%CI=4.79-8.50).Nearly three-quarters of health insurance participants experience out-of-pocket expenditures for contraceptive services. Out-of-pocket expenditures of contraceptive services significantly associate with the type of health insurance owned and the types of contraceptive methods used.

Health insurance and contraceptive use, Indonesian Family Planning Census 2021

“…Most studies available were conducted before the integration, and focused on certain types of health insurance and certain regions. 11 , 12 Hence, the findings cannot be widely generalized. To understand the benefits of this policy in increasing the use of modern contraceptives and reducing fertility rates in Indonesia, it is important to determine the relationship between health insurance coverage and use of modern contraceptives.…”

Can a National Health Insurance Policy Increase Modern Contraceptive Use? A Cross-Sectional Study of the Indonesian Government Performance and Accountability Survey (GPAS) 2019

“…Using Indonesian Social Economic Data from 2012 to 2016, Nasution et al (2020) concluded that, until 2016, the implementation of the universal health insurance program did not increase the prevalence of contraceptive usage in Indonesia. In the district of Sleman, Sulistiawan et al (2021) reported that out-of-pocket expenditures for contraceptive services were significantly associated with the type of health insurance owned and the types of contraceptive methods used. Accordingly, the present study examines the influence of the universal health insurance policy (JKN) following the integration of family planning services into the policy in 2016.…”