What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia

IF 3.2 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Afina Nur Fauziyyah, Akira Shibanuma, Ken Ing Cherng Ong, Masamine Jimba
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引用次数: 0

Abstract

Ensuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries’ primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia. The setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants’ choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses. BPJS-Health partners’ geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners’ services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities. Sociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants’ primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners’ coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.
印尼万隆的一项横断面研究:在医疗保险计划限制下,哪些因素会影响人们对初级保健的选择?
确保平等获得初级保健服务至关重要,因为这是通往更高级保健的门户。印度尼西亚自2014年以来一直在努力通过管理名为BPJS-Health(Badan Penyelenggara Jaminan Sosial Kesehatan)的国家医疗保险来增加获得医疗服务的经济机会。然而,BPJS-Health 的受益人只能在数量有限的注册初级医疗服务提供者(BPJS-Health 合作伙伴)处使用其福利。本研究调查了 BPJS-Health 的地理覆盖范围,以及 BPJS-Health 受益人在印度尼西亚万隆目标地区的特征和医疗偏好基础上的初级医疗选择。这项横断面研究的背景是,BPJS-Health 合作伙伴的实际可及性较低,而非 BPJS-Health 合作伙伴的实际可及性较高的地区。通过空间网络分析确定了实际可达性,并绘制了地理覆盖图。共招募了 216 名成年人,他们填写了关于初级保健选择的问卷。所有参与者均已在 BPJS-Health 系统注册,并居住在研究地区。他们参与非 BPJS-Health 系统的情况也在评估之列。在三种不同的情况下,即个人患有轻症、慢性病和重病时,对参与者的护理选择进行了评估。BPJS-Health 合作伙伴在万隆的地域分布不均。在非 BPJS-Health 公司注册与 BPJS-Health 受益人更频繁地选择使用 BPJS-Health 合作伙伴的服务呈负相关(AOR = 0.18;95% CI,0.06-0.58,P = 0.004)。在重病方面,高收入与选择非 BPJS-Health 合作伙伴和医院有关(AOR = 4.90;95% CI,1.16-20.77,P = 0.031)。在治疗轻度和慢性疾病时,参试者会将治疗质量作为选择初级医疗服务提供者的一个主要因素。然而,在所有疾病严重程度的情况下,获得更好的治疗质量与选择 BPJS-Health 合作伙伴呈负相关。在印度尼西亚万隆的目标地区,社会人口特征、医疗保健偏好因素和医疗保险状况与参与者的初级保健选择有关。BPJS-Health合作伙伴的覆盖图和偏好因素对政策制定者,尤其是对未来BPJS-Health合作伙伴关系的发展具有潜在的重要意义。
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来源期刊
BMC Family Practice
BMC Family Practice 医学-医学:内科
CiteScore
3.20
自引率
0.00%
发文量
0
审稿时长
4-8 weeks
期刊介绍: BMC Family Practice is an open access, peer-reviewed journal that considers articles on all aspects of primary health care research. The journal has a special focus on clinical decision making and management, continuing professional education, service utilization, needs and demand, and the organization and delivery of primary care and care in the community.
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