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All Journal Jurnal Manajemen Pelayanan Publik Narra J Journal of Indonesian Health Policy and Administration
Widyasanti, Nisrina
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Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Social Sciences Transportation

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Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia Bachtiar, Adang; Candi, Cicilya; Hasibuan, Syarif R.; Widyasanti, Nisrina; Kusuma, Dian
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.969

Abstract

Coronary heart disease (CHD) remains a leading cause of mortality in Indonesia, and coronary artery bypass graft (CABG) surgery is frequently employed to manage arterial blockages. Despite its efficacy, the recurrence of heart disease post-surgery is a significant concern, highlighting the need for a deeper understanding of its influencing factors. The aim of this study was to examine the factors associated with the incidence of heart disease recurrence after coronary bypass surgery. This study employed a prospective observational design, analyzing hospital claim data from Indonesia's Social Security Agency for Health, known as Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, from 2017 to 2022. The analysis included 5,947 patients who survived CABG surgery. Multivariable logistic regression was utilized to assess the relationship between patient demographics, comorbidities, socioeconomic status, and compliance with follow-up visits, as well as their impact on the recurrence of cardiovascular disease. The study found that 24.1% of patients experienced hospitalization recurrence. Patients with irregular follow-ups were less likely to experience recurrence (adjusted odds ratio (AOR): 0.63; 95%CI: 0.51–0.78). Other significant risk factors for recurrence included being self-employed (AOR: 2.09; 95%CI: 1.72–2.55), having comorbid conditions such as disorders of fluid, electrolyte, and acid-base balance (AOR: 3.55; 95%CI: 2.97–4.24), and experiencing cerebral infarction or stroke (AOR: 10.85; 95%CI: 8.24–14.29). In contrast, older age (AOR: 0.89; 95%CI: 0.88–0.91) and the presence of non-insulin-dependent diabetes mellitus (AOR: 0.35; 95%CI: 0.29–0.42) were associated with a lower risk of recurrence. Sex did not significantly influence the risk of recurrence (AOR: 1.18; 95%CI: 0.86–1.62). In conclusion, the study indicates a considerable rate of cardiovascular disease recurrence post-CABG in Indonesia, highlighting several key risk factors. Tailored postoperative management and strict adherence to follow-up protocols are essential for mitigating recurrence. These findings offer crucial insights for improving post-CABG health management strategies in Indonesia.
Referral Patterns from Primary Care to Referral Care by ICD-10 Codes in Indonesia: Cross-Sectional Analysis of National Claims Data (2017–2024) Ayu, Della Dwi; Hasibuan, Syarif Rahman; Pradnyani, Putu Erma; Widyasanti, Nisrina
Journal of Indonesian Health Policy and Administration Vol. 11, No. 2
Publisher : UI Scholars Hub

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Abstract

Primary health care (PHC) facilities serve as gatekeepers within Indonesia’s tiered health system. However, PHC referral patterns to hospitals still show substantial variation and remain insufficiently characterized by disease groupings based on the International Classification of Diseases, 10th Revision (ICD-10). This study aimed to identify the most frequently referred diagnoses from PHC to secondary or tertiary care facilities and to determine the participant characteristics associated with referrals. This observational study employed a cross-sectional design using secondary data from the National Health Insurance (Jaminan Kesehatan Nasional – JKN) claims database for the period 2017–2024. The unit of analysis was each patient visit to a PHC facility. The outcome variable was referral status (referred vs. not referred), with ICD-10 diagnostic codes as the main independent variable, while age and sex were covariates. Descriptive and inferential analyses, including binary logistic regression, were conducted to identify factors associated with referral likelihood. Of 1.2 billion visit episodes, 14% resulted in referrals to higher-level facilities. The most frequent diagnoses were classified under ICD-10 Code J (respiratory system diseases, 21.5%), yet referrals were most common among cases under Code C (neoplasms). Referrals were also more frequent among older adults and male patients.
Analysis of Equity in Access to Cataract Surgery Services Among BPJS Kesehatan Participants Ikhsan, M; Hasibuan, Syarif Rahman; Widyasanti, Nisrina; Utomo, Wahyudi; Akbar, Taufik
Jurnal Manajemen Pelayanan Publik Vol 10, No 2 (2026): Jurnal Manajemen Pelayanan Publik
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jmpp.v10i2.69399

Abstract

Cataract is the leading cause of avoidable blindness worldwide, yet equitable access to surgery remains a challenge despite universal health coverage. This study examines equity in cataract surgery utilization among participants of Indonesia’s national health insurance program using logistic regression and a multilayer perceptron (MLP) model. Findings show that age, sex, marital status, place of residence, and insurance segment are significantly associated with surgery utilization. Male participants, older age groups, and certain insurance segments are more likely to undergo surgery, indicating structural inequities in access. These findings underscore the need to strengthen referral mechanisms, reduce access barriers, and improve public service management policies within JKN to advance equity in essential eye care services.
Co-Authors Adang Bachtiar Candi, Cicilya Della Dwi Ayu Dian Kusuma Erma Pradnyani, Putu Hasibuan, Syarif R. M Ikhsan Syarif Rahman Hasibuan Taufik Akbar Utomo, Wahyudi