印度尼西亚残疾人的医疗保险覆盖范围、医疗保健利用情况及经济保障：2021年全国社会经济调查分析
Health insurance coverage, healthcare use, and financial protection amongst people with disabilities in Indonesia: analysis of the 2021 National Socioeconomic Survey.
作者信息
Azizatunnisa' Luthfi, Probandari Ari, Kuper Hannah, Banks Lena Morgon
机构信息
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
出版信息
Lancet Reg Health Southeast Asia. 2025 Jul 9;39:100631. doi: 10.1016/j.lansea.2025.100631. eCollection 2025 Aug.
BACKGROUND
(JKN), Indonesia's mandatory national health insurance scheme and the world's largest single-payer system, has not been rigorously evaluated for its reach and effectiveness amongst people with disabilities, who often have greater healthcare needs. This study evaluates JKN coverage and its association with healthcare use and financial protection for people with disabilities in Indonesia.
METHODS
This cross-sectional study analysed the Indonesia National Socioeconomic Survey (Susenas) March 2021 dataset (n = 1,277,497). Disability was measured using the Washington Group Short Set (WG-SS). We used multivariate logistic regression to examine associations between disability and health insurance coverage, and between insurance coverage and healthcare utilization, out-of-pocket payments (OOP), and catastrophic health expenditure (CHE).
FINDINGS
Around 30% of people with disabilities were uninsured, and 35% were not enrolled in JKN, with coverage lower in the lowest socioeconomic groups, living in rural areas, or self-employment. Among JKN-enrolees, they were more likely to be in the subsidised group (vs. contributory) compared to those without disabilities. Overall, people with disabilities utilised healthcare services more frequently and incurred higher OOP and CHE than those without disabilities. These disparities were not mitigated by insurance coverage. Indeed, people with disabilities, even with JKN coverage, were more likely to experience high OOP and CHE, with those in the contributory group facing a higher likelihood of CHE than the subsidised group.
INTERPRETATION
There are large gaps in health insurance coverage for people with disabilities in Indonesia. Additionally, there is an urgent need to enhance the financial protection of people with disabilities, ensuring equitable and comprehensive care.
FUNDING
This study is part of the first author's PhD project, funded by the Indonesia Endowment Fund for Education (LPDP).
背景
印度尼西亚的强制性国家健康保险计划（JKN）是世界上最大的单一支付者系统，但尚未对其在残疾人群体中的覆盖范围和有效性进行严格评估，而残疾人群体往往有更大的医疗保健需求。本研究评估了JKN在印度尼西亚残疾人群体中的覆盖情况及其与医疗保健使用和经济保护的关联。
方法
这项横断面研究分析了2021年3月印度尼西亚全国社会经济调查（Susenas）数据集（n = 1,277,497）。使用华盛顿小组简表（WG-SS）测量残疾情况。我们使用多变量逻辑回归来检验残疾与健康保险覆盖之间的关联，以及保险覆盖与医疗保健利用、自付费用（OOP）和灾难性医疗支出（CHE）之间的关联。
结果
约30%的残疾人群体未参保，35%未加入JKN，在社会经济地位最低的群体、农村地区居民或自营职业者中，覆盖水平较低。在加入JKN的人群中，与非残疾人群相比，他们更有可能属于补贴组（相对于缴费组）。总体而言，残疾人群体比非残疾人群更频繁地使用医疗保健服务，自付费用和灾难性医疗支出更高。这些差距并未因保险覆盖而得到缓解。事实上，即使有JKN覆盖，残疾人群体仍更有可能经历高额自付费用和灾难性医疗支出，缴费组的人群比补贴组面临更高的灾难性医疗支出可能性。
解读
印度尼西亚残疾人群体的健康保险覆盖存在巨大差距。此外，迫切需要加强对残疾人群体的经济保护，确保公平和全面的护理。
资金
本研究是第一作者博士项目的一部分，由印度尼西亚教育捐赠基金（LPDP）资助。
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