Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Primary Care and Public Health, Imperial College London, London, London, UK.
BMJ Glob Health. 2023 Jan;8(1). doi: 10.1136/bmjgh-2021-007758.
Evidence suggests that women gave birth in diverse types of health facilities and were assisted by various types of health providers. This study examines how these choices are influenced by the Indonesia national health insurance programme (Jaminan Kesehatan Nasional (JKN)), which aimed to provide equitable access to health services, including maternal health.
Using multinomial logit regression models, we examined patterns and determinants of women's choice for childbirth, focusing on health insurance coverage, geographical location and socioeconomic disparities. We used the 2018 nationally representative household survey dataset consisting of 41 460 women (15-49 years) with a recent live birth.
JKN coverage was associated with increased use of higher-level health providers and facilities and reduced the likelihood of deliveries at primary health facilities and attendance by midwives/nurses. Women with JKN coverage were 13.1% and 17.0% (p<0.05) more likely to be attended by OBGYN/general practitioner (GP) and to deliver at hospitals, respectively, compared with uninsured women. We found notable synergistic effects of insurance status, place of residence and economic status on women's choice of type of birth attendant and place of delivery. Insured women living in Java-Bali and in the richest wealth quintile were 6.4 times more likely to be attended by OBGYN/GP and 4.2 times more likely to deliver at a hospital compared with those without health insurance, living in Eastern Indonesia, and in the poorest income quantile.
There are large variations in the choice of birth attendant and place of delivery by population groups in Indonesia. Evaluation of health systems reform initiatives, including the JKN programme and the primary healthcare strengthening, is essential to determine their impact on disparities in maternal health services.
有证据表明，妇女在不同类型的卫生机构分娩，并由不同类型的卫生提供者提供帮助。本研究考察了印度尼西亚国家健康保险计划（Jaminan Kesehatan Nasional (JKN)）如何影响这些选择，该计划旨在提供公平获得包括孕产妇保健在内的卫生服务的机会。
我们使用多项逻辑回归模型，考察了妇女选择分娩方式的模式和决定因素，重点关注医疗保险覆盖范围、地理位置和社会经济差异。我们使用了 2018 年具有代表性的全国家庭调查数据集，其中包括 41460 名（15-49 岁）最近分娩的妇女。
JKN 覆盖范围与使用更高层次的卫生提供者和设施的增加以及在初级卫生设施分娩和由助产士/护士护理的可能性降低有关。与未参保的妇女相比，有 JKN 覆盖的妇女由妇产科医生/全科医生（GP）护理的可能性分别增加了 13.1%和 17.0%（p<0.05），并且更有可能在医院分娩。我们发现保险状况、居住地和经济状况对妇女选择分娩助手类型和分娩地点有显著的协同作用。在爪哇-巴厘岛居住和最富裕的五分之一财富的参保妇女，由妇产科医生/GP 护理的可能性是没有医疗保险、居住在印度尼西亚东部和最贫穷收入五分位数的妇女的 6.4 倍，在医院分娩的可能性是后者的 4.2 倍。
印度尼西亚人口群体在选择分娩助手和分娩地点方面存在很大差异。评估卫生系统改革举措，包括 JKN 计划和加强初级保健，对于确定其对孕产妇保健服务差异的影响至关重要。
