Department of Community and Global Health, The University of Tokyo, Tokyo, Japan.
Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.
BMC Prim Care. 2024 Feb 21;25(1):64. doi: 10.1186/s12875-024-02296-6.
Ensuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries' primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia.
The setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants' choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses.
BPJS-Health partners' geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners' services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities.
Sociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants' primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners' coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.
确保初级保健服务的平等获取至关重要，因为这是获得更高水平医疗服务的门户。自 2014 年以来，印度尼西亚一直在通过管理国家健康保险（BPJS-Health）来增加医疗保健的财务获取途径，该保险被称为 BPJS-Health（Badan Penyelenggara Jaminan Sosial Kesehatan）。然而，BPJS-Health 的受保人只能在有限数量的注册初级保健提供者（BPJS-Health 合作伙伴）处使用其福利。本研究根据印度尼西亚万隆地区的目标人群的特征和医疗保健偏好，调查了 BPJS-Health 的地理覆盖范围以及 BPJS-Health 受保人对初级保健的选择。
这项横断面研究的背景是，BPJS-Health 合作伙伴的身体可达性较差，但非 BPJS-Health 合作伙伴的身体可达性较高的地区。身体可达性是通过空间网络分析确定的，从而生成了地理覆盖图。共招募了 216 名成年人，他们完成了有关初级保健选择的问卷。所有参与者均已在 BPJS-Health 系统中注册，并居住在研究区域内。还评估了他们参与非 BPJS-Health 的情况。在三种不同情况下评估了参与者的护理选择，即个人患有轻度，慢性和严重疾病时。
BPJS-Health 合作伙伴的地理覆盖范围在万隆分布不均。在 BPJS-Health 受保人中，与非 BPJS-Health 公司注册有关的因素与更频繁地选择使用 BPJS-Health 合作伙伴服务呈负相关（AOR = 0.18；95%CI，0.06-0.58，P = 0.004）。对于严重疾病，高收入与选择非 BPJS-Health 合作伙伴和医院有关（AOR = 4.90；95%CI，1.16-20.77，P = 0.031）。在处理轻度和慢性疾病时，参与者主要关注他们将获得的治疗质量，这是选择初级保健提供者的主要因素。但是，在所有疾病严重程度的情况下，获得更好的治疗质量与选择 BPJS-Health 合作伙伴呈负相关。
社会人口统计学特征，医疗保健偏好因素和健康保险状况与印度尼西亚万隆地区参与者的初级保健选择有关。BPJS-Health 合作伙伴的覆盖范围图和偏好因素对政策制定者，特别是对未来 BPJS-Health 合作伙伴关系的发展具有重要意义。
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