Mental Health Service Utilization among Older Adults in Indonesia: Nationwide Retrospective Cohort Study Using the National Health Insurance Claims Data, 2015-2023.

Abstract

Background: Mental health disorders among older adults are an increasing global concern, with depression affecting up to 30% globally and even higher in developing countries. In Indonesia, despite high prevalence, little is known about how mental health services are utilized by older adults under the National Health Insurance (JKN) program. This study aims to examine patterns of mental health service utilization among older adults (aged ≥60 years) enrolled in the JKN program.

Methods: We conducted a retrospective cohort study using the 2024 BPJS Kesehatan Mental Health Contextual Sample, which was based on stratified random sampling. The sample included 5,966 older adults who were alive by December 31, 2023, and had at least one mental health diagnosis (International Classification of Diseases 10th revision [ICD-10] F00-F99). JKN membership categories include formal workers (PPU), informal workers (PBPU), government-subsidized groups (PBI), and non-workers. Data analysis included descriptive statistics and generalized linear modeling to assess factors associated with service utilization.

Results: Anxiety and neurotic disorders were the most common diagnoses (36.0%), followed by psychotic disorders (28.3%) and mood disorders (19.0%). The mean number of visits per person per year was 4.94±5.18. The PPU group had higher utilization than other participant groups, while those never married and those in higher ward classes had significantly lower utilization. Age was inversely associated with service use. No significant differences were observed by gender or divorce status.

Conclusion: These findings highlight the value of administrative claims data to monitor mental health service use in later life. Efforts to address disparities across sociodemographic groups could enhance equitable access to mental healthcare for older adults.