Background
Methods
Study setting
Data collection
Data variables
Analysis
Results
Baseline analysis
Variables | 2018 n (%) | 2019 n (%) |
---|---|---|
Health insurance coverage | ||
Public (JKN) | 4,126 (64.0) | 4,672 (72.5) |
Private | 109 (1.7) | 72 (1.1) |
No coverage | 2,210 (34.3) | 1,701 (26.4) |
Residence | ||
Urban | 3,951 (61.3) | 3,668 (56.9) |
Rural | 2,494 (38.7) | 2,777 (43.1) |
Employment of the head of household | ||
Unemployed | 474 (7.6) | 551 (8.7) |
Civil servant | 349 (5.6) | 350 (5.5) |
Private employee | 731 (11.7) | 863 (13.6) |
Self-employed (informal sector) | 4,712 (75.2) | 4,570 (72.2) |
Average household monthly expenditures (in IDR, 000) | ||
Poorest, Q1 | 871 | 909 |
Poorer, Q2 | 1,537 | 1,698 |
Middle, Q3 | 2,048 | 2,364 |
Richer, Q4 | 2,688 | 3,353 |
Richest, Q5 | 5,303 | 6,664 |
Number of children under five years old | ||
None | 4,626 (71.8) | 4,829 (74.9) |
One or more | 1,819 (28.2) | 1,616 (25.1) |
Number of adult aged 60 + | ||
None | 4,425 (68.7) | 4,256 (66.0) |
One or more | 2,020 (31.3) | 2,189 (34.0) |
Distribution of outpatient care in the last month | ||
Public only | 1,147 (17.8) | 952 (14.8) |
Private | 1,777 (25.6) | 1,327 (20.6) |
Not using outpatient care | 3,521 (54.6) | 4,166 (64.6) |
Distribution of inpatient care in the last year | ||
Public only | 694 (10.8) | 510 (7.9) |
Private | 455 (7.1) | 465 (7.2) |
Not using inpatient care | 5,296 (82.2) | 5,470 (84.9) |
Number of individuals and reasons for not seeking care | 108 | 43 |
The pain is not severe | 48 | 5 |
Unable to pay medical expenses | 24 | 20 |
Long and long queues | 22 | 4 |
Other | 14 | 14 |
Outpatient | Inpatient | |||||||
---|---|---|---|---|---|---|---|---|
2018 | 2019 | 2018 | 2019 | |||||
Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
Health insurance coverage | ||||||||
Public (JKN) | 268 | 3,244 | 128 | 545 | 1,596 | 5,041 | 1,347 | 5,159 |
Private | 294 | 421 | 1,007 | 2,515 | 1,863 | 4,548 | 7,849 | 22,200 |
No coverage | 215 | 831 | 138 | 310 | 2,328 | 3,494 | 2,970 | 4,315 |
Household monthly expenditure quintile | ||||||||
Poorest, Q1 | 118 | 576 | 92 | 341 | 1,481 | 3,257 | 1,046 | 2,600 |
Poorer, Q2 | 84 | 129 | 135 | 639 | 1,124 | 2,103 | 1,125 | 2,211 |
Middle, Q3 | 106 | 193 | 127 | 446 | 1,346 | 4,052 | 1,225 | 2,652 |
Richer, Q4 | 370 | 453 | 131 | 655 | 1,843 | 5,287 | 1,261 | 3,219 |
Richest, Q5 | 485 | 3,026 | 186 | 541 | 2,668 | 6,190 | 2,731 | 9,380 |
Type of health provider | ||||||||
Public only | 124 | 619 | 78 | 443 | 1,339 | 3,606 | 1,267 | 6,132 |
Private | 301 | 3,032 | 169 | 594 | 2,410 | 5,846 | 1,981 | 4,854 |
OOP components | ||||||||
Doctors’ fees | 187 | 477 | 74 | 108 | 3,195 | 3,922 | 818 | 1,374 |
Administration | 138 | 617 | 82 | 476 | 2,346 | 3,307 | 2,143 | 5,212 |
Drugs and diagnostics | 289 | 3,047 | 165 | 591 | 3,018 | 6,730 | 2,127 | 4,963 |
Room^ | NA | NA | NA | NA | NA | NA | 1,830 | 2038 |
Transportation | 45 | 381 | 22 | 36 | 178 | 557 | 295 | 4,594 |
Food | 100 | 549 | 72 | 500 | 365 | 450 | 316 | 833 |
Informal payments | 5 | 7 | 7 | 37 | 66 | 272 | 57 | 398 |
2018 % (95% CI) | 2019 % (95% CI) | |||
---|---|---|---|---|
All households | 7.9 (7.3, 8.6) | 4.4 (4.0, 5.0) | ||
Health insurance coverage | P = 0.001 | P = 0.031 | ||
Public (JKN) | 7.0 (6.2, 7.8) | 4.0 (3.5, 4.6) | ||
Private | 10.1 (5.1, 17.3) | 5.6 (1.5, 13.6) | ||
No coverage | 9.6 (8.4, 10.9) | 5.5 (4.5, 6.7) | ||
Residence | P < 0.001 | P = 0.095 | ||
Urban | 6.8 (6.1, 7.7) | 4.1 (3.5, 4.8) | ||
Rural | 9.7 (8.5, 10.9) | 4.9 (4.2, 5.8) | ||
Employment of the head of household | P < 0.001 | P = 0.135 | ||
Unemployed | 13.0 (10.1, 16.4) | 6.4 (4.5, 8.8) | ||
Civil servant | 11.2 (8.1, 15.0) | 4.9 (2.9, 7.9) | ||
Private employee | 5.9 (4.3, 7.8) | 4.1 (2.8, 5.6) | ||
Self-employed | 7.6 (6.8, 8.4) | 4.3 (3.7, 4.9) | ||
Household monthly expenditure quintile | P = 0.002 | P = 0.012 | ||
Poorest, Q1 | 9.7 (8.2, 11.5) | 5.6 (4.4, 7.0) | ||
Poorer, Q2 | 7.2 (5.9, 8.7) | 4.7 (3.6, 6.0) | ||
Middle, Q3 | 6.4 (5.1, 7.9) | 4.4 (3.4, 5.7) | ||
Richer, Q4 | 6.9 (5.5, 8.4) | 3.9 (2.9, 5.1) | ||
Richest, Q5 | 9.5 (7.9, 11.2) | 3.6 (2.6, 4.7) | ||
Number of children under five years old | P = 0.002 | P < 0.001 | ||
None | 7.3 (6.5, 8.1) | 3.7 (3.2, 4.3) | ||
One or more | 9.6 (8.3, 11.1) | 6.6 (5.4, 7.9) | ||
Number of adult aged 60+ | P < 0.001 | P = 0.040 | ||
None | 6.9 (6.2, 7.8) | 4.1 (3.5, 4.7) | ||
One or more | 10.1 (8.8, 11.5) | 5.2 (4.3, 6.2) | ||
Type of outpatient care provider | P < 0.001 | P < 0.001 | ||
Public only | 7.6 (6.1, 9.3) | 4.5 (3.3, 6.0) | ||
Private | 19.8 (18.0, 21.7) | 14.3 (12.5, 16.3) | ||
Not using outpatient care | 2.0 (1.6, 2.6) | 1.3 (1.0, 1.7) | ||
Type of inpatient care provider | P = 0.001 | P < 0.001 | ||
Public only | 19.3 (16.4, 22.4) | 10.2 (7.7, 13.2) | ||
Private | 27.7 (23.6, 32.1) | 18.1 (14.7, 22.0) | ||
Not using inpatient care | 4.7 (4.2, 5.4) | 2.7 (2.3, 3.2) |
Variables | 2018 Odds ratio (95% CI) | P-value | 2019 Odds ratio (95% CI) | P-value | ||
---|---|---|---|---|---|---|
Health insurance coverage | ||||||
No coverage | ref | ref | ||||
Public (JKN) | 0.61 (0.49–0.77) | < 0.001 | 0.48 (0.35–0.65) | < 0.001 | ||
Private | 0.86 (0.39–1.86) | 0.694 | 0.82 (0.25–2.69) | 0.748 | ||
Location | ||||||
Rural | ref | ref | ||||
Urban | 0.66 (0.54–0.82) | < 0.001 | 1.13 (0.86–1.48) | 0.368 | ||
Employment of the head of household | ||||||
Unemployment | ref | ref | ||||
Civil servant | 1.20 (0.73–1.98) | 0.476 | 1.09 (0.55–2.14) | 0.804 | ||
Private employee | 0.52 (0.32–0.83) | 0.006 | 0.83 (0.48–1.44) | 0.507 | ||
Self-employed | 0.71 (0.50–0.99) | 0.047 | 0.81 (0.53–1.24) | 0.334 | ||
Household income quintile | ||||||
Poorest (Q1) | ref | ref | ||||
Poorer (Q2) | 0.59 (0.43–0.81) | 0.001 | 0.50 (0.33–0.74) | 0.001 | ||
Middle (Q3) | 0.43 (0.31–0.59) | < 0.001 | 0.47 (0.31–0.70) | < 0.001 | ||
Richer (Q4) | 0.47 (0.34–0.66) | < 0.001 | 0.31 (0.20–0.47) | < 0.001 | ||
Richest (Q5) | 0.53 (0.39–0.73) | < 0.001 | 0.23 (0.15–0.37) | < 0.001 | ||
Number of children under five years old | ||||||
None | ref | ref | ||||
One or more | 0.99 (0.79–1.24) | 0.923 | 1.21 (0.91–1.61) | 0.187 | ||
Number of residents aged 60+ | ||||||
None | ref | ref | ||||
One or more | 1.18 (0.95–1.47) | 0.138 | 1.10 (0.83–1.47) | 0.499 | ||
Outpatient care provider | ||||||
Public | ref | ref | ||||
Private | 3.70 (2.80–4.90) | < 0.001 | 3.96 (2.73–5.74) | < 0.001 | ||
Not using outpatient care | 0.29 (0.21–0.40) | < 0.001 | 0.27 (0.18–0.41) | < 0.001 | ||
Inpatient care provider (ref = public) | ||||||
Public | ref | ref | ||||
Private | 1.34 (0.97–1.86) | 0.079 | 1.70 (1.11–2.59) | 0.014 | ||
Not using inpatient care | 0.16 (0.12–0.21) | < 0.001 | 0.17 (0.12–0.25) | < 0.001 |
Pooled data analysis
Variables | Odds ratio (95% CI) | P-value | Odds ratio (95% CI) | P-value |
---|---|---|---|---|
Health insurance coverage | ||||
No coverage | ref | |||
Public (JKN) | 0.52 (0.42–0.65) | < 0.001 | 0.55 (0.42–0.72)a | < 0.001 |
Private | 0.91 (0.43–1.94) | 0.814 | 0.89 (0.37–2.17)b | 0.806 |
Location | ||||
Rural | ref | ref | ||
Urban | 0.79 (0.64–0.96) | 0.019 | 0.79 (0.64–0.96) | 0.020 |
Employment of the head of household | ||||
Unemployment | ref | ref | ||
Civil servant | 1.26 (0.78–2.06) | 0.345 | 1.26 (0.78–2.06) | 0.346 |
Private employee | 0.59 (0.38–0.90) | 0.016 | 0.59 (0.38–0.90) | 0.015 |
Self-employed | 0.72 (0.52–0.99) | 0.045 | 0.72 (0.52–0.99) | 0.045 |
Household income quintile | ||||
Poorest (Q1) | ref | ref | ||
Poorer (Q2) | 0.51 (0.38–0.69) | < 0.001 | 0.51 (0.38–0.68) | < 0.001 |
Middle (Q3) | 0.38 (0.28–0.51) | < 0.001 | 0.38 (0.28–0.52) | < 0.001 |
Richer (Q4) | 0.35 (0.26–0.48) | < 0.001 | 0.35 (0.26–0.48) | < 0.001 |
Richest (Q5) | 0.34 (0.25–0.47) | < 0.001 | 0.34 (0.25–0.47) | < 0.001 |
Number of children under five years old | ||||
None | ref | ref | ||
One or more children | 1.09 (0.88–1.34) | 0.440 | 1.09 (0.88–1.35) | 0.431 |
Number of residents aged 60+ | ||||
None | ref | ref | ||
One or more | 1.21 (0.98–1.49) | 0.079 | 1.21 (0.98–1.49) | 0.079 |
Outpatient care provider | ||||
Public | ||||
Private | 4.80 (3.63–6.35) | < 0.001 | 4.80 (3.63–6.34) | < 0.001 |
Not using outpatient care | 0.22 (0.16–0.30) | < 0.001 | 0.22 (0.16–0.30) | < 0.001 |
Inpatient care provider | ||||
Public | ref | ref | ||
Private | 1.68 (1.22–2.30) | 0.001 | 1.68 (1.23–2.30) | 0.001 |
Not using inpatient care | 0.11 (0.08–0.15) | < 0.001 | 0.11 (0.08–0.15) | < 0.001 |
Survey round | ||||
First wave | ref | |||
Second wave | 0.66 (0.55–0.80) | < 0.001 | 0.73 (0.53–1.01)a | 0.061 |
Insurance type # survey round | ||||
No coverage # first wave | ref | |||
JKN # second wave | 0.85 (0.57–1.28)b | 0.446 | ||
Private # second wave | 1.09 (0.22–5.43)c | 0.918 | ||
JKN, Jaminan Kesehatan Nasional; CI, confidence interval; ref, reference group *Two observations from first wave were excluded due to missing data. a comparison is made between households with no health insurance in the second wave and households with no health insurance in the first wave (reference) b comparison is made between households with JKN in the second wave and households with no health insurance in the first wave (reference) c comparison is made between households with private health insurance in the second wave and households with no health insurance in the first wave (reference) |