Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Health Office of Bandung City, Bandung, West Java, Indonesia.
BMC Public Health. 2022 May 12;22(1):952. doi: 10.1186/s12889-022-13142-8.
The health insurance system in Indonesia was transformed in 2014 to achieve universal health coverage (UHC). The effective implementation of essential primary health services through UHC has resulted in efficient healthcare utilisation, which is reflected in the health-seeking behaviour of the community. Our study aimed to examine the changes in health-seeking behaviour before and after the implementation of UHC in Indonesia and to identify what factors determine these changes.
We conducted a retrospective cohort study using the recall method and data collected through questionnaire-based interviews in Bandung, Indonesia. We used a two-step sampling technique-randomised sampling and purposive sampling, and a total of 579 respondents with acute or chronic episodes were recruited. [Formula: see text] tests were used to identify the association between factors. Difference in difference model and a logistic regression model for binary outcomes were used to estimate the effect of the implementation of UHC on the health-seeking behaviour.
Utilisation of public health facilities increased significantly after implementation of UHC, from 34.9% to 65.4% among the respondents with acute episodes and 33.7% to 65.8% among those with chronic episodes. The odds of respondents going to health facilities when they developed an acute episode increased after the implementation of UHC (OR = 1.22, p = 0.05; AOR = 1.42, p < 0.001). For respondents experiencing chronic episodes, the implementation of UHC increased the odds ratio (OR = 1.74, p < 0.001; AOR = 1.64, p < 0.001) that they would use health facilities. Five years after the implementation of UHC, we still found respondents who did not have health insurance (26 and 19 respondents among those with acute episode and chronic episode, respectively).
The effect of the implementation of UHC seemed greater for those experiencing chronic episodes than for those with an acute episode. Although the implementation of UHC has improved utilisation of public health facilities, the presence of people who are not covered by health insurance is a potential problem that could threaten future improvements in healthcare access and utilisation.
2014 年，印度尼西亚对医疗保险制度进行了改革，以实现全民健康覆盖（UHC）。通过全民健康覆盖实现基本初级卫生服务的有效实施，导致医疗保健的有效利用，这反映在社区的寻医行为上。我们的研究旨在调查印度尼西亚实施全民健康覆盖前后寻医行为的变化，并确定决定这些变化的因素。
我们使用回忆法进行回顾性队列研究，并使用问卷调查进行数据收集，地点在印度尼西亚万隆。我们使用两步抽样技术（随机抽样和目的抽样），共招募了 579 名患有急性或慢性疾病的受访者。[公式：见正文]检验用于确定因素之间的关联。差异中的差异模型和二项结果的逻辑回归模型用于估计全民健康覆盖的实施对寻医行为的影响。
在实施全民健康覆盖后，急性疾病患者前往公共卫生机构的比例从 34.9%显著增加到 65.4%，慢性疾病患者从 33.7%增加到 65.8%。实施全民健康覆盖后，出现急性疾病时受访者前往卫生机构的可能性增加（OR=1.22，p=0.05；AOR=1.42，p<0.001）。对于患有慢性疾病的受访者，全民健康覆盖的实施增加了他们使用卫生机构的比值比（OR=1.74，p<0.001；AOR=1.64，p<0.001）。在实施全民健康覆盖五年后，我们仍然发现没有医疗保险的受访者（急性疾病和慢性疾病患者中分别有 26 名和 19 名受访者）。
全民健康覆盖的实施对慢性疾病患者的影响似乎大于急性疾病患者。尽管全民健康覆盖的实施提高了公共卫生机构的利用率，但没有医疗保险的人群的存在是一个潜在的问题，可能威胁到未来医疗保健获取和利用的改善。
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