<![CDATA[Background: Universal health coverage (UHC) aims to ensure equitable access to quality healthcare services. Indonesia's National Health Insurance (BPJS Kesehatan), covering 248.8 million people, provides unprecedented opportunities to examine cancer survival patterns under UHC implementation. However, survival outcomes and factors influencing mortality among cancer patients within this system remain underexplored. Objective: To analyze survival outcomes and identify factors associated with mortality among cancer patients covered by Indonesia's National Health Insurance from 2017-2023. Methods: A retrospective longitudinal cohort study was conducted using BPJS Kesehatan administrative data. From a database of 2.501.251 JKN participants, 2.444 patients with cancer diagnoses (ICD-10: C00-C97) were identified. After applying eligibility criteria, 330 patients diagnosed since 2017 were eligible, with 316 patients included in final analysis after excluding incomplete data. Cox proportional hazards regression was employed to identify factors associated with survival time. Variables analyzed included comorbidity status, insurance scheme type, regional healthcare access, regional setting, age groups, and gender. Results: The analysis included 316 cancer patients with overall mortality rate of 52.8%. Female patients comprised 64.9% of the cohort, with 47.8% in the 40-59 years age group. Urban (Kota) patients represented 77.5%. Patients with documented mild complications showed significantly better survival (HR=0.360, 95% CI: 0.331-0.392, p<0.001) compared to those without complications. Severe complications also demonstrated improved survival (HR=0.482, 95% CI: 0.440-0.527, p<0.001). Insurance scheme type emerged as a critical factor, with PBI APBN patients showing 2.3-fold increased death hazard (HR=2.306, 95% CI: 2.086-2.548, p<0.001), while PBPU patients had 55% reduced hazard (HR=0.445, 95% CI: 0.412-0.479, p<0.001). Substantial regional variations were observed, with Regional 3 showing 3-fold increased death hazard (HR=2.957, 95% CI: 2.682-3.260, p<0.001). Age group 40-59 years demonstrated optimal survival (HR=0.553, 95% CI: 0.514-0.596, p<0.001). Female patients showed 26% increased death hazard (HR=1.259, 95% CI: 1.185-1.338, p<0.001), and rural (Kabupaten) patients had 54% increased survival (HR=1.535, 95% CI: 1.426-1.653, p<0.001) compared to urban patients. Conclusion: Cancer survival outcomes under Indonesia's universal health coverage system are significantly influenced by insurance scheme type, complication documentation status, regional healthcare access, urban-rural disparities, age, and gender, revealing substantial inequities within the UHC framework that require targeted policy interventions to achieve equitable cancer care.]]>
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