Indonesia‘s Universal Healthcare System Reveals Starkโ Disparities in Renal Failure Treatment
jakarta, Indonesia – Aโ new cross-sectional analysis โคofโฃ nationalโ health insurance claims โdata reveals significant โinequitiesโค in access to hemodialysis for patients โwith renal failure โขacrossโข Indonesia, despite the country’s commitment to โuniversal health coverage. The study,examining claims from 2017 to 2022,demonstrates โฃthat membership โคtype within the BPJS Kesehatan national โhealthโ insurance system,geographicโค location,socioeconomic status,sex,and facility type all playโ a role in โwhether or not patients receive this โฃlife-sustaining treatment.
The โanalysis, published recently, โfound that 75.6% (29,017 of 38,383) ofโข renal failure claims resulted in hemodialysis. However, access wasn’t uniform.Individuals โidentified as informal workers and those subsidized under local government budgets exhibited higher odds of receiving hemodialysis compared toโค those with national government subsidies. Conversely,formalโข sectorโฃ workers had lower odds. These โfindings underscore criticalโฃ gaps in equitable โaccess to โคcare within the BPJS Kesehatan system,โฃ impacting vulnerable โpopulations and โฃhindering progress toward universal health coverage.
The study utilized multivariateโ logistic regression, robustโข standard errors, and probability weights to account for the complex sample design. Results showed informal workers had a 1.56 times higherโ odds (95% โฃCI: 1.34-1.82; P<.001) and locally subsidizedโ members had a 1.31 times higher odds (95% CI: 1.05-1.63; P=.017) of receiving hemodialysisโ compared to thoseโ nationallyโ subsidized. Formal sector workers had 0.81 times the odds (95% CI: โ0.68-0.98; P=.028). โฃdisparities โwere particularly pronouncedโ in rural โขareas, where locally subsidized members had more than twice the odds of โขreceiving hemodialysis compared to nationally subsidized members (aOR 2.40, 95% CI: 1.78-3.23).
Further analysisโ revealed significant demographic and geographic variations. Men โขhad higher odds โof receiving hemodialysis than women (aOR 1.17, 95% โCI: 1.04-1.32), and โyounger patients โคwere more โฃlikely โto receive treatment โthanโ older ones. โRegional access was dramatically uneven, with patients in Java โฃor Bali having 8.30 times โคgreater access (95% CI 5.33-12.94) compared to those in eastern โฃIndonesia (Papua, maluku, and Nusa Tenggara). Treatmentโ location also mattered; patients at private facilities (aOR 1.30, 95% CI 1.13-1.50) andโข in outpatient settings (aOR โฃ3.74,โ 95% โCI 3.36-4.17) were more likely to receive hemodialysis, while thoseโ at lower-level hospitals or clinicsโ wereโ less likely.
Researchers conclude that urgentโ policy interventions are needed โคto address โthese disparities. Enhancing healthโฃ infrastructure, improving service distribution, and reducing socioeconomic and geographic barriersโ are crucial steps toward achieving equitable access to renal care services and fulfilling Indonesia’s โuniversal health coverageโข goals. The study highlightsโ the need โforโ targeted strategies to support low-income populations, rural residents, women, and those residing in less โคadvantaged regions of the โฃcountry.