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Health Care Spending for Cardiovascular Disease under National Health Insurance Scheme in Indonesia Before and During COVID-19: Descriptive Analysis and PolicyRecommendations Nurwahyuni, Atik; Soewondo, Prastuti; Nadjib, Mardiati; Farianti, Yuli; Mukhlisa, Mazda Novi; Wahyuningsih, Helmi; Mangunsong, Emmy Ridhawaty; Athiyah, Athiyah; Yunita, Yunita; Sayekti, Sekar Arum Handarbeni; Sari, Kurnia; Megraini, Amila
Journal of Indonesian Health Policy and Administration Vol. 8, No. 2
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Abstract

The Cardiovascular disease (CVD) prevalence continues to increase. This study aims to identify the CVD spending and utilization in the Indonesia National Health Insurance (JKN) scheme 2017-2021 using the JKN claims classified by Disease Accounts analyzed descriptively. The CVD spending increased by $125,4 million in 2019 compared to 2017 and mostly for the hospital (91% in 2019) with the highest spending occurring in the age above 60 years. Moreover, the hospital inpatient spending was dominated during these five years. The highest portion of spending by severity level was at mild level, followed by moderate and severe levels. Health facilities’ capacities across the regions remain the issue in providing health services, especially for the CVD that require further treatment using advanced technology. The CVD cost continues to increase annually; fortunately, the JKN plays a key role as financial protection for participants. But, there was a decrease in the number of visits and spending on CVD during the COVID-19 pandemic because of lockdown policies and health systems shifting to provide capacity to overcome COVID-19. The decrease in the number of visits to health facilities raises the potential of being diagnosed later with more severe. As policy recommendations, strengthening primary care screening and hospital capacity across regions through implementing the Health System Transformation are expected to reduce the impact of these problems.
Evaluasi Implementasi Jaminan Persalinan (Jampersal) di Indonesia Mukhlisa, Mazda Novi; Estetika, Rosa
Jurnal Ekonomi Kesehatan Indonesia Vol. 5, No. 2
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Jampersal as a transfer fund from central to district government is provided to support maternal and child health services aiming to increase access to health services for pregnant women, childbirth and postpartum mothers, also newborns to competent health facilities. This analysis aimed to evaluate the use of Jampersal in increasing institutional delivery using quantitative and qualitative approaches. For the quantitative approach, this analysis used Riskesdas 2018 and routine data from the Ministry of Health. The data was analyzed using benefit incidence analysis (BIA) and linear regression. The quantitative approach was conducted at two levels, the individual level (80,459 pregnant women) and the district level (407 districts), whereas the qualitative approach was conducted in eight districts to enrich quantitative results. Information was managed using content analysis. Results indicated that Jampersal held 3.75% of the total funding of child delivery. Jampersal spending tends to increase every year and is utilized mostly for services. BIA showed that Jampersal is widely used by mothers whose heads of households are at the primary education level. Regression analysis showed that every rupiah spent in Jampersal increases institutional delivery, although it is not statistically significant (coefficient 0.000726; robust SE 0.00370; p-value> 0.1).
The Effect of Health Insurance on Institutional Delivery in Indonesia Mukhlisa, Mazda Novi; Pujiyanto, Pujiyanto
Kesmas Vol. 12, No. 3
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Pemanfaatan pelayanan persalinan di fasilitas kesehatan berdampak pada menurunnya angka kematian ibu (AKI). Di Indonesia, persalinan di fasilitas kesehatan mengalami peningkatan setiap tahunnya, tetapi masih terdapat sekitar 30% ibu yang bersalin di rumah. Sayangnya, peningkatan pemanfaatan pelayanan persalinan di fasilitas kesehatan tersebut tidak diimbangi dengan penurunan AKI, sehingga Indonesia tidak berhasil mencapai target MDGs. Untuk mencapai Universal Health Coverage, Indonesia mengimplementasikan program Jaminan Kesehatan Nasional (JKN) yang mengintegrasikan empat jaminan kesehatan, yaitu Askes/ASABRI, Jamsostek, Jamkesmas, dan Jamkesda. Jaminan kesehatan dapat mengatasi kendala biaya pada persalinan di fasilitas kesehatan. Dengan menggunakan data Riset Kesehatan Dasar 2013 dan data Potensi Desa 2011 sebagai sumber data, penelitian ini bertujuan menganalisis bahwa kepemilikan jaminan kesehatan meningkatkan pemanfaatan pelayanan persalinan di fasilitas kesehatan di Indonesia. Sampel penelitian berjumlah 39.942 perempuan berusia 15-49 tahun yang melahirkan anak terakhir dalam periode waktu 2010-2013. Penelitian ini menggunakan pendekatan ekonometri dengan model estimasi probit dan bivariat probit untuk mengestimasi efek jaminan kesehatan dengan mempertimbangkan isu endogenitas pada jaminan kesehatan. Hasil penelitian menunjukkan bahwa kepemilikan jaminan kesehatan meningkatkan persalinan di fasilitas kesehatan sebesar 39,52%. Sebagai kesimpulan, ibu yang memiliki jaminan kesehatan akan lebih memanfaatkan fasilitas kesehatan saat persalinan dibandingkan dengan ibu yang tidak memiliki jaminan kesehatan. Institutional delivery has an impact on the decline in maternal mortality rate. In Indonesia, institutional delivery increases every year, but there are still 30%-37% mothers who deliver at home. Unfortunately, the increase is not in line with maternal mortality reduction, so that Indonesia does not achieve the fifth MDGs goal. To achieve Universal Health Coverage, Indonesia implements National Health Insurance (NHI). NHI integrates four types of health insurance, namely Askes/ASABRI, Jamsostek, Jamkesmas and Jamkesda. One of its benefits is maternal health services. Health insurance can address financial barriers on delivery in health facility. By using secondary data of National Basic Health Research 2013 and Village Potential 2011 data, this study aimed to analyze effect of health insurance on institutional delivery in Indonesia. Samples were 39,942 women aged 15-49 years old who gave birth to their last child during 2010-2013. The study used econometric approach by applying probit and bivariate probit as estimation model to estimate the effect with consideration to endogeneity issue of health insurance. The results found that health insurance was likely to increase institutional delivery by 39.52%. In conclusion, women who have health insurance prefer to deliver birth at health facility compared to those who do not have health insurance.
The Effect of Health Insurance on Institutional Delivery in Indonesia Mukhlisa, Mazda Novi; Pujiyanto, Pujiyanto
Kesmas Vol. 12, No. 3
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Pemanfaatan pelayanan persalinan di fasilitas kesehatan berdampak pada menurunnya angka kematian ibu (AKI). Di Indonesia, persalinan di fasilitas kesehatan mengalami peningkatan setiap tahunnya, tetapi masih terdapat sekitar 30% ibu yang bersalin di rumah. Sayangnya, peningkatan pemanfaatan pelayanan persalinan di fasilitas kesehatan tersebut tidak diimbangi dengan penurunan AKI, sehingga Indonesia tidak berhasil mencapai target MDGs. Untuk mencapai Universal Health Coverage, Indonesia mengimplementasikan program Jaminan Kesehatan Nasional (JKN) yang mengintegrasikan empat jaminan kesehatan, yaitu Askes/ASABRI, Jamsostek, Jamkesmas, dan Jamkesda. Jaminan kesehatan dapat mengatasi kendala biaya pada persalinan di fasilitas kesehatan. Dengan menggunakan data Riset Kesehatan Dasar 2013 dan data Potensi Desa 2011 sebagai sumber data, penelitian ini bertujuan menganalisis bahwa kepemilikan jaminan kesehatan meningkatkan pemanfaatan pelayanan persalinan di fasilitas kesehatan di Indonesia. Sampel penelitian berjumlah 39.942 perempuan berusia 15-49 tahun yang melahirkan anak terakhir dalam periode waktu 2010-2013. Penelitian ini menggunakan pendekatan ekonometri dengan model estimasi probit dan bivariat probit untuk mengestimasi efek jaminan kesehatan dengan mempertimbangkan isu endogenitas pada jaminan kesehatan. Hasil penelitian menunjukkan bahwa kepemilikan jaminan kesehatan meningkatkan persalinan di fasilitas kesehatan sebesar 39,52%. Sebagai kesimpulan, ibu yang memiliki jaminan kesehatan akan lebih memanfaatkan fasilitas kesehatan saat persalinan dibandingkan dengan ibu yang tidak memiliki jaminan kesehatan. Institutional delivery has an impact on the decline in maternal mortality rate. In Indonesia, institutional delivery increases every year, but there are still 30%-37% mothers who deliver at home. Unfortunately, the increase is not in line with maternal mortality reduction, so that Indonesia does not achieve the fifth MDGs goal. To achieve Universal Health Coverage, Indonesia implements National Health Insurance (NHI). NHI integrates four types of health insurance, namely Askes/ASABRI, Jamsostek, Jamkesmas and Jamkesda. One of its benefits is maternal health services. Health insurance can address financial barriers on delivery in health facility. By using secondary data of National Basic Health Research 2013 and Village Potential 2011 data, this study aimed to analyze effect of health insurance on institutional delivery in Indonesia. Samples were 39,942 women aged 15-49 years old who gave birth to their last child during 2010-2013. The study used econometric approach by applying probit and bivariate probit as estimation model to estimate the effect with consideration to endogeneity issue of health insurance. The results found that health insurance was likely to increase institutional delivery by 39.52%. In conclusion, women who have health insurance prefer to deliver birth at health facility compared to those who do not have health insurance.