Income Disparity and Healthcare Utilization: Lessons from Indonesia’s National Health Insurance Claim Data

Abstract

Background: Indonesia’s National Health Insurance Program, known as Jaminan Kesehatan Nasional (JKN), has a variety of membership pathways for those wishing to gain access. Claim data from JKN offers a cost-effective way of observing who is accessing healthcare services and what types of services are being used. This study is a novel attempt to measure disparities amongst JKN users in their engagement with services, providing an opportunity to reflect on patterns of use. Methods: Using claims data collected from JKN users between 2015–2016, we used the Ordinary Least Square estimation model to compare health services utilization among subsidized and non-subsidized users. We focused primarily on the individual use of the hospital for outpatient and inpatient treatment. Results: Analysis reveals that subsidized users access primary healthcare services more frequently than non-subsidized users. Conversely, non-subsidized users access secondary and tertiary health care services more frequently than other users. Subsidized users who utilize secondary and tertiary health care tend to suffer more severe health illnesses than non-subsidized members. Conclusions: This study concludes that income disparity affects healthcare utilization. Non-subsidized members are more likely than subsidized members to access secondary and tertiary health care services. Our study offers evidence of the potential underutilization of secondary and tertiary healthcare (STHC) by subsidized members, which could lead to inefficiency since subsidized members seeking STHC treatment had severe health conditions, thus needing to be treated longer and requiring higher healthcare expenditures.

Risk Factors Contributing to Disparities in Medical Treatment and Lower Survival Rates among Patients with Non-Small Cell Lung Cancer Induced by Residential Areas

“…Additionally, long-distance travel poses difficulties for certain patients, such as the elderly or those with comorbidities. Therefore, several factors may be related to travel distance to the hospital for patients with cancer receiving treatment [3][4][5].There are disparities in cancer mortality rates among the 47 prefectures in Japan, and Aomori Prefecture, one of the depopulated areas in Japan, has had the highest cancer mortality rate since 2004 [6]. Aomori Prefecture is divided into six medical areas, and cancer-specialist hospitals are located in all areas except Area 4 (Figure 1).…”

“…Additionally, long-distance travel poses difficulties for certain patients, such as the elderly or those with comorbidities. Therefore, several factors may be related to travel distance to the hospital for patients with cancer receiving treatment [3][4][5].…”