Path Analysis on the Equity of Hemodialysis Utilization in the National Health Insurance Program in Jember, East Java
Abstract
Background: Since 2014, Indonesia has implemented a National Health Insurance to cover public health costs. The existence of health insurance managed by the government is expected to help all levels of society to obtain health services. This is very helpful for the community, especially for patients with chronic diseases who need continuous treatment. This study aims to analyze the fairness and determinants of the use of hemodialysis patients with chronic kidney failure in National Health Insurance participants in Jember Regency.
Subject and Method: This was observational analytic study with cross sectional approach, conducted at Dr. Soebandi Hospital and Kaliwates General Hospital, Jember, East Java. A total Study subjects of 200 patients with chronic kidney failure undergoing hemodialysis with JKN membership were selected for this study by purposive sampling. The dependent variable was the use of hemodialysis. The independent variables were JKN membership status, length of time since diagnosis, disease severity, age, education, family income, access to health facilities and residence. Data collection used questionnaires and medical record documents and then analyzed using path analysis.
Results: The possibility of using hemodialysis was increased by the Non PBI status (b= 0.81; 95% CI= 0.16 to 1.47; p= 0.015), high disease severity (b=2.48; 95% CI=0.36 to 4.59; p= 0.022), age ≥ 50 years old (b=0.65; 95% CI = 0.33 to 1.26; p= 0.039), family income ≥ MW (b= 0.59; 95% CI= -0.07 to 1.24; p= 0.080) and good access to health facility (b= 0.92; 95% CI= -0.19 to 1.66; p= 0.013). The possibility of using hemodialysis was indirectly affected by the length of time since diagnosis, education and residence.
Conclusions: The possibility of using hemodialysis was increased by Non PBI status, disease severity, age, family income, and access to health facilities. The possibility of using hemodialysis was indirectly affected by the length of time since diagnosis, education, and residence.
Keywords: National Health Insurance, justice, hemodialysis, path analysis
Correspondence: Siti Nafi’atus Salamah. Public Health Sciences Study Program, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: sitinafiatus27@gmail.com. Mobile: 081289434401
Journal of Health Policy and Management (2020), 5(2): 108-120
https://doi.org/10.26911/thejhpm.2020.05.02.03
References
Agustina R, Dartanto T, Sitompul R, et al. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet. 393 (10166): 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7
Agustini C (2012). Hubungan cara bayar, jarak tempat tinggal dan dukungan keluarga dengan kepatuhan berobat rawat jalan pasien skizofrenia di RSJD Surakarta (The relationship of payment methods, distance of residence and family support with adherence
to outpatient treatment of schizophrenics patients in Surakarta Central Hospital). Tesis. Universitas Muhammadiyah Surakarta. Retrieved from https://docplayer.info/64715112-Hubu-ngan-cara-bayar-jarak-tempat-tinggal-dan-dukungan-keluarga-dengan-kepa-tuhan-berobat-rawat-jalan-pasien-ski-zofrenia-di-rsjd-surakarta-tesis.html
Andersen RM (1995). Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 36 (1): 1–10. https://doi.org/10.2307/2137284
Ardian K, Sulaeman ES, Suryono A (2017). Social economic equity in the utilization of hemodialysis among patients with chronic renal failure under national health insurance plan at Dr. Moewardi Hospital, Surakarta. J Health Policy Manage. 02 (01):
–41. https://doi.org/10.26911/thejhpm.2017.01.02.03
BPJS Kesehatan. (2017). Ringkasan Eksekutif Pengelolaan Program dan Laporan Keuangan Jaminan Sosial Kesehatan (Executive Summary of Program Management and Financial Report of Social Health Insurance). Retrieved from https://www.bpjskesehatan.go.id/bpjs/dmdocuments/b39df9ae7a30a5c7d4bd0f54d763b447.pdf
Braveman P, Gruskin S (2003). Defining equity in health. J Epidemiol Community Health. 57 (4): 254–258. https://doi.org/10.1136/jech.57.4.254
De Andrade LOM, Filho AP, Solar O, et al. (2015). Social determinants of health, universal health coverage, and sustainable development: Case studies from Latin American countries. The Lancet. 385 (9975): 1343–1351. https://doi.org/10.1016/S0140-6736-(14)61494-X
Djunawan A (2018). Pengaruh jaminan kesehatan terhadap pemanfaatan pelayanan kesehatan primer di perkotaan Indonesia: adilkah bagi masyarakat miskin? (The effect of health insurance on the utilization of primary health services in Indonesian cities:
is it fair for the poor?). Berita Kedokteran Masyarakat. 5 (12): 5. https://doi.org/10.22146/bkm.37474
Doi S, Ide H, Takeuchi K, Fujita S, Takabayashi K (2017). Estimation and evaluation of future demand and sup-ply of healthcare services based on a patient access area model. Int J Environ Res Public Health. 14 (11): 1367. https://doi.org/10.3390/ijerph14111367
Erawatyningsih E, Purwanta, Subekti H (2009). Faktor-faktor yang mempengaruhi ketidakpatuhan berobat pada penderita tuberkulosis paru (Factors that influence non-compliance with treatment in patients with pulmonary tuberculosis). Berita Kedokteran
Masyarakat. 25 (3): 117–124. https://doi.org/10.22146/bkm.3558
Idn Times (2019). BPJS: Biaya penyakit gagal ginjal termahal kedua di JKN (BPJS: The second most expensive cost of kidney failure in JKN). Retrieved from https://www.idntimes.com/news/indonesia/indianamalia/bpjs-biaya-penyakit-gagal-ginjal-termahal-kedua-di-jkn/full
Indonesian Renal Registry (2016). 9th Report of Indonesian Renal Registry. Tim Indonesian Renal Registry. Jakarta.
Kim C (2016). Public health policy. Health Policy and Management. 26 (4): 256–264. https//doi.org/10.4332/KJHPA.2016.26.4.256
Kizilcik Z, Sayiner FD, Unsal A, Ayranci U, Kosgeroglu N, Tozun M (2012). Prevalence of depression in patients on hemodialysis and its impact on quality of life. Pak J Med Sci. 28 (4): 695-699. Retrieved from http://applications.emro.who.int/imemrf/Pak_J_Med_Sci/Pak_J_Med_Sci_2012_28_4_695_699.pdf
Manurung AM (2008). Hubungan perceived dan evaluated need perawatan karies gigi dengan pemanfaatan pelayanan kesehatan gigi pada masyarakat di Kota Pematang Siantar (Correlation between perceived and evaluated need of dental caries treatment with
the utilization of dental health services in the community in Pematang Siantar City). Tesis. Universitas Sumatera Utara. Retrieved from https://docplayer.info/storage/54/344-20925/34420925.pdf
Nainggolan O, Hapsari D, Indrawati L (2016). Pengaruh akses ke fasilitas ke-sehatan terhadap kelengkapan imuni-sasi baduta (analisis Riskesdas 2013) (Effect of access to health facilities on the completeness of immunization in under two years old
(Basic Health Research 2013 analysis)). Media Penelitian Dan Pengembangan Kesehatan. 26 (1): 15–28. https://doi.org/10.22435/mpk.v26i1.4900.15-28
Napirah MR, Rahman A, Tony A (2016). Faktor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan di wilayah kerja Puskesmas Tambarana Kecamatan Poso Pesisir Utara Kabupaten Poso (Factors related to the utilization of health services in the
working area of Tambarana Health Center, Poso Pesisir Utara District, Poso District). Jurnal Pengembangan Kota. 4 (1): 29-39. https://doi.org/10.14710/jpk.4.1.29-39
Nord C, Mykletun A, Thorsen L, Bjøro T, Fosså SD (2005). Self-reported health and use of health care services in longterm cancer survivors. Int J Cancer. 114 (2): 307–316. https://doi.org/10.1002/ijc.20713
Norris K, Nissenson AR (2008). Race, gender, and socioeconomic disparities in CKD in the United States. J Am Soc Nephrol. 19 (7): 1261–1270. https://doi.org/10.1681/ASN.2008030276
Nugroho RH, Murti B, Suryono A (2019). Disparity in health care utilization by income level and insurance status at Gamping Muhammadiyah Hospital, Yogyakarta, Indonesia. J Health Policy Manage. 4 (3): 195-203. https://doi.org-/10.26911/thejhpm.2019.04.03.07
Oktaviana MN (2015). Hubungan antara persepsi kerentanan individu, keseriusan penyakit, manfaat dan hambatan dengan penggunaan skrining inspeksi visual asam asetat pada wanita usia subur (Relationship between perception of individual vulnerability,
seriousness of disease, benefits and barriers to the use of visual inspection of acetic acid screening in women of childbearing age). Tesis. Universitas Sebelas Maret. Retrieved from https://digilib.uns.ac.id/dokumen/detail/48508/Hubungan-Antara-Persepsi-Kerentanan-Individu-Keseriusan-Penyakit-Manfaat-dan-Hambatan-dengan-Penggunaan-Skrining-Inspeksi-Visual-Asam-Asetat-pada-Wanita-Usia-Subur
Permatasari NT, Rochmah TN (2013). Ana-lisis vertical equity pada pemanfaatan pelayanan kesehatan (Analysis of vertical equity in the utilization of health services). Jurnal Administrasi Kesehatan Indonesia. 1 (1): 83-90. Retrieved from https://media.neliti.com/media-/publications/3843IDvertical-equity-analysis-on-healthcare-utilization.pdf
Rumengan DSS, Umboh JML, Kandou GD (2015). Faktor-faktor yang berhubu-ngan dengan pemanfaatan pelayanan kesehatan pada peserta BPJS Keseha-tan di Puskesmas Paniki Bawah Keca-matan Mapanget Kota Manado (Factors related to the utilization of health
services in Health BPJS participants in the Paniki Bawah Health Center in the Mapanget subdistrict of Manado City). Jikmu Suplemen. 05 (1): 88–100. https://doi.org/10.1016/j.psychres.2014.11.019
Soeroso J, Judajana FM (2014). Hubungan antara umur, umur mulai sakit, lama sakit dengan LED, CRP, DAS28-LED di artritis rheumatoid (Relationship between age, age of illness, duration of illness with LED, CRP, DAS28-LED in rheumatoid arthritis). Indonesian
Journal of Clinical Pathology and Medical Laboratory. 20 (2): 85-92. Retrieved from https://indonesianjournalof-clinicalpathology.org/index.php/pa-tologi/article/download/1072/793
Syamsiah N (2011). Faktor-faktor yang berhubungan dengan kepatuhan pasien CKD yang menjalani hemodialisis di RSPAU Dr. Esnawan Antariksa Halim Perdana Kusuma Jakarta (Factors related to adherence of CKD patients undergoing hemodialysis at RSPAU Dr.
Esnawan Antariksa Halim Perdana Kusuma Jakarta). Tesis. Universitas Indonesia. Retrieved from http://lib.ui.ac.id/file?file=digital/20281994-T%20Nita%20Syamsiah.pdf
Wang WL, Liang S, Zhu FL, Liu JQ, et al. (2019). The prevalence of depression and the association between depres-sion and kidney function and health-related quality of life in elderly patients with chronic kidney disease: A multicenter cross-sectional
study. Clin Interv Aging. 14: 905–913. https://doi.-org/10.2147/CIA.S203186
Whitehead M (1992). The concepts and principles of equity and health. Int J Health Serv. 22 (3): 429–445. https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN
Yandrizal, Suryani D, Anita B, Febriawati H (2014). Analisis ketersediaan fasilitas kesehatan dan pemerataan pelayanan pada pelaksanaan jaminan kesehatan nasional di Kota Bengkulu, Kabupaten Seluma dan Kabupaten Kaur (Analysis of the availability
of health facilities and even distribution of services in the implementation of national health insurance in Bengkulu City, Seluma Regency and Kaur Regency). Jurnal Kebijakan Kesehatan Indonesia. 3 (2): 103-112. https://doi.org/10.22146/jkki.-36383
