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Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia

BACKGROUND: 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...

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Autores principales: Kosasih, Dadan Mulyana, Adam, Sony, Uchida, Mitsuo, Yamazaki, Chiho, Koyama, Hiroshi, Hamazaki, Kei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102261/
https://www.ncbi.nlm.nih.gov/pubmed/35549931
http://dx.doi.org/10.1186/s12889-022-13142-8
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author Kosasih, Dadan Mulyana
Adam, Sony
Uchida, Mitsuo
Yamazaki, Chiho
Koyama, Hiroshi
Hamazaki, Kei
author_facet Kosasih, Dadan Mulyana
Adam, Sony
Uchida, Mitsuo
Yamazaki, Chiho
Koyama, Hiroshi
Hamazaki, Kei
author_sort Kosasih, Dadan Mulyana
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13142-8.
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spelling pubmed-91022612022-05-14 Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia Kosasih, Dadan Mulyana Adam, Sony Uchida, Mitsuo Yamazaki, Chiho Koyama, Hiroshi Hamazaki, Kei BMC Public Health Research BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13142-8. BioMed Central 2022-05-12 /pmc/articles/PMC9102261/ /pubmed/35549931 http://dx.doi.org/10.1186/s12889-022-13142-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visithttp://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Kosasih, Dadan Mulyana
Adam, Sony
Uchida, Mitsuo
Yamazaki, Chiho
Koyama, Hiroshi
Hamazaki, Kei
Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia
title Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia
title_full Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia
title_fullStr Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia
title_full_unstemmed Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia
title_short Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia
title_sort determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in indonesia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102261/
https://www.ncbi.nlm.nih.gov/pubmed/35549931
http://dx.doi.org/10.1186/s12889-022-13142-8
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