Ahsan Abdillah, Baros Wan Aisyiah, Siregar Dedy Revelino, Pertiwi Yuyu Buono Ayuning, Utami Maulida Gadis, Aminde Leopold, Manurung Khaterina Kristina, Febriyanti Maya
Department of Economics, University of Indonesia Faculty of Economics and Business, Depok, Indonesia
Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia.
BMJ Open. 2025 May 2;15(5):e091115. doi: 10.1136/bmjopen-2024-091115.
This study investigated the correlation between the type of health insurance membership as a proxy for the economic status of patients and the severity of their type two diabetes mellitus (T2DM) in Indonesia.
The study conducted a secondary analysis of National Health Insurance (Jaminan Kesehatan Nasional) claim data provided by the Indonesian Social Security Agency, (BPJS). We used ordered logistic regression with four severity levels for T2DM (0=outpatient, I=mild, II=moderate, III=severe) as dependent variables. The main independent variables (insurance membership categories) included subsidised insurance members (PBI), a combination of formally employed and nonsalaried informal workers (PBPU & PPU) and nonworkers (BP).
Secondary healthcare facilities in Indonesia.
The dataset included 2 989 618 claims for hospital visits of people with T2DM from 2018 to 2022.
Severity level of T2DM patients.
A higher percentage of T2DM patients who visited healthcare facilities with subsidised insurance (PBI), which represents a low-income group, have severe disease (6.9%) than patients in the PBPU & PPU (4.9%) and BP categories (5.5%). Moreover, regression analysis revealed that having PBI membership status was associated with a greater OR of having severe T2DM than nonsubsidised members. Among T2DM patients in the nonsubsidised insurance category, workers (PBPU & PPU) had an OR of 0.74 (95% CI: 0.735 to 0.745; p<0.0001) for having severe disease during hospital visits. Moreover, non-workers (BP) had a lower OR of 0.718 (95% CI: 0.711 to 0.725; p<0.0001) for severe disease than the PBI category.
These findings illustrate the lack of optimal access to health services for diabetes patients in low-income insurance membership categories and the challenges of better treatment in health facilities for low-income patients.
本研究调查了作为患者经济状况指标的医疗保险类型与印度尼西亚2型糖尿病（T2DM）患者病情严重程度之间的相关性。
该研究对印度尼西亚社会保障局（BPJS）提供的国民健康保险（Jaminan Kesehatan Nasional）索赔数据进行了二次分析。我们使用有序逻辑回归，将T2DM的四个严重程度级别（0 = 门诊，I = 轻度，II = 中度，III = 重度）作为因变量。主要自变量（保险会员类别）包括补贴保险会员（PBI）、正式雇员和非受薪非正式工人的组合（PBPU & PPU）以及非工人（BP）。
印度尼西亚的二级医疗设施。
该数据集包括2018年至2022年期间2989618例T2DM患者的医院就诊索赔。
T2DM患者的严重程度级别。
在代表低收入群体的补贴保险（PBI）类别中，前往医疗机构就诊的T2DM患者中患有严重疾病的比例（6.9%）高于PBPU & PPU类别（4.9%）和BP类别（5.5%）的患者。此外，回归分析显示，拥有PBI会员身份与患有严重T2DM的比值比高于非补贴会员。在非补贴保险类别的T2DM患者中，工人（PBPU & PPU）在医院就诊期间患有严重疾病的比值比为0.74（95%置信区间：0.735至0.745；p<0.0001）。此外，非工人（BP）患有严重疾病的比值比（0.718，95%置信区间：0.711至0.725；p<0.0001）低于PBI类别。
这些发现表明低收入保险会员类别中的糖尿病患者缺乏获得最佳医疗服务的机会，以及低收入患者在医疗机构中获得更好治疗面临的挑战。
