Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.
Centre for Health Economics and Policy Studies, University of Indonesia, Jakarta, Indonesia.
Int J Equity Health. 2021 Nov 4;20(1):239. doi: 10.1186/s12939-021-01577-1.
For many low and middle-income countries poor quality health care is now responsible for a greater number of deaths than insufficient access to care. This has in turn raised concerns around the distribution of quality of care in LMICs: do the poor have access to lower quality health care compared to the rich? The aim of this study is to investigate the extent of inequalities in the availability of quality health services across the Indonesian health system with a particular focus on differences between care delivered in the public and private sectors.
Using the Indonesian Family Life Survey (wave 5, 2015), 15,877 households in 312 communities were linked with a representative sample of both public and private health facilities available in the same communities. Quality of health facilities was assessed using both a facility service readiness score and a knowledge score constructed using clinical vignettes. Ordinary least squares regression models were used to investigate the determinants of quality in public and private health facilities.
In both sectors, inequalities in both quality scores existed between major islands. In public facilities, inequalities in readiness scores persisted between rural and urban areas, and to a lesser extent between rich and poor communities.
In order to reach the ambitious stated goal of reaching Universal Health Coverage in Indonesia, priority should be given to redressing current inequalities in the quality of care.
对于许多中低收入国家而言，医疗质量差导致的死亡人数已超过因医疗服务获取不足导致的死亡人数。这反过来又引发了人们对中低收入国家医疗服务质量分布的担忧：与富人相比，穷人能否获得更低质量的医疗服务？本研究旨在调查印度尼西亚卫生系统内医疗服务质量供给不平等的程度，尤其关注公共和私营部门之间的差异。
利用印度尼西亚家庭生活调查（第五波，2015 年），对 312 个社区中的 15877 户家庭与同一社区内可用的公共和私人卫生机构的代表性样本进行了关联。利用机构服务准备就绪评分和使用临床病例构建的知识评分来评估卫生设施的质量。采用普通最小二乘法回归模型来研究公共和私人卫生机构质量的决定因素。
在两个部门中，主要岛屿之间的质量评分都存在不平等。在公共设施中，准备就绪评分在城乡之间存在不平等，在贫富社区之间也存在不平等，但程度较小。
为了实现印度尼西亚普及全民健康覆盖的宏伟目标，应优先考虑纠正当前医疗服务质量方面的不平等。
