A Qualitative Study: Early Detection of Breast Cancer in Indonesia (After Universal Health Coverage Implementation)

Abstract

ObjectivesEarly detection is of vital importance in breast cancer management. BPJS Kesehatan, as Indonesia’s national health insurance, is expected to provide an adequate health service for breast cancer patients. This study aimed to obtain insight into the current conditions of health care services in Indonesia, related to early detection of breast cancer, particularly after BPJS Kesehatan implementation. MethodsThe study was conducted in 2017 in Yogyakarta, Indonesia with a wide range of socio-demographic backgrounds. Subjects comprised breast cancer patients and their relatives, health care professionals (HCPs), and healthy women from the general population who had no history of breast cancer and no family members with breast cancer. The subjects’ experiences and knowledge of health care services regarding early detection of breast cancer, were investigated through in-depth interviews. The thematic analysis guided the result synthesis from semi-structured in-depth interviews with 25 participants.ResultsDespite more patients with earlier stages presenting in high level of care after the implementation of universal coverage, this study identified the lack of both screening as well as diagnostic procedures as a prominent obstacle in breast cancer management. Study results indicated a lack of knowledge and misperception among the community about breast cancer screening. Also, problems in implementing early diagnosis were revealed such as the lack of urgency and access for patients to get a proper diagnostic procedure. Furthermore, varying adherence to the guidelines in all levels of care were found. ConclusionsThis study identified several issues that cause delay in the detection of breast cancer in Indonesia. All these factors lead to suboptimal breast cancer management. BPJS Kesehatan (the national health insurance) must focus its attention on the improvement of enabling factors in all levels of care for early detection (i.e. increasing awareness, access, referral system and facilities).