Indonesia‘s Universal Healthcare System Reveals Stark Disparities in Renal Failure Treatment
jakarta, Indonesia – A new cross-sectional analysis of national health insurance claims data reveals significant inequities in access to hemodialysis for patients with renal failure across Indonesia, despite the country’s commitment to universal health coverage. The study,examining claims from 2017 to 2022,demonstrates that membership type within the BPJS Kesehatan national health insurance system,geographic location,socioeconomic status,sex,and facility type all play a role in whether or not patients receive this life-sustaining treatment.
The analysis, published recently, found that 75.6% (29,017 of 38,383) of renal failure claims resulted in hemodialysis. However, access wasn’t uniform.Individuals identified as informal workers and those subsidized under local government budgets exhibited higher odds of receiving hemodialysis compared to those with national government subsidies. Conversely,formal sector workers had lower odds. These findings underscore critical gaps in equitable access to care within the BPJS Kesehatan system, impacting vulnerable populations and hindering progress toward universal health coverage.
The study utilized multivariate logistic regression, robust standard errors, and probability weights to account for the complex sample design. Results showed informal workers had a 1.56 times higher odds (95% CI: 1.34-1.82; P<.001) and locally subsidized members had a 1.31 times higher odds (95% CI: 1.05-1.63; P=.017) of receiving hemodialysis compared to those nationally subsidized. Formal sector workers had 0.81 times the odds (95% CI: 0.68-0.98; P=.028). disparities were particularly pronounced in rural areas, where locally subsidized members had more than twice the odds of receiving hemodialysis compared to nationally subsidized members (aOR 2.40, 95% CI: 1.78-3.23).
Further analysis revealed significant demographic and geographic variations. Men had higher odds of receiving hemodialysis than women (aOR 1.17, 95% CI: 1.04-1.32), and younger patients were more likely to receive treatment than older ones. Regional access was dramatically uneven, with patients in Java or Bali having 8.30 times greater access (95% CI 5.33-12.94) compared to those in eastern Indonesia (Papua, maluku, and Nusa Tenggara). Treatment location also mattered; patients at private facilities (aOR 1.30, 95% CI 1.13-1.50) and in outpatient settings (aOR 3.74, 95% CI 3.36-4.17) were more likely to receive hemodialysis, while those at lower-level hospitals or clinics were less likely.
Researchers conclude that urgent policy interventions are needed to address these disparities. Enhancing health infrastructure, improving service distribution, and reducing socioeconomic and geographic barriers are crucial steps toward achieving equitable access to renal care services and fulfilling Indonesia’s universal health coverage goals. The study highlights the need for targeted strategies to support low-income populations, rural residents, women, and those residing in less advantaged regions of the country.
