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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.