Tiara Marthias, Barbara McPake, Natalie Carvalho, Christopher Millett, Kanya Anindya, Nurmala Selly Saputri, Laksono Trisnantoro, John Tayu Lee
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We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014.</p><p><strong>Findings: </strong>JKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation.</p><p><strong>Interpretation: </strong>Expansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.</p>","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations between Indonesia's national health insurance, effective coverage in maternal health and neonatal mortality: a multilevel interrupted time-series analysis 2000-2017.\",\"authors\":\"Tiara Marthias, Barbara McPake, Natalie Carvalho, Christopher Millett, Kanya Anindya, Nurmala Selly Saputri, Laksono Trisnantoro, John Tayu Lee\",\"doi\":\"10.1136/jech-2021-217213\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We assessed the effect of Indonesia's national health insurance programme (<i>Jaminan Kesehatan Nasional</i> (<i>JKN</i>)) on effective coverage for maternal and child health across geographical regions and population groups.</p><p><strong>Methods: </strong>We used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15-49 years and 144 000 birth records. 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引用次数: 0
摘要
背景:我们评估了印度尼西亚国家医疗保险计划(Jaminan Kesehatan Nasional (JKN))对不同地区和人群的妇幼保健有效覆盖率的影响:我们评估了印度尼西亚国家医疗保险计划(Jaminan Kesehatan Nasional,JKN)对不同地理区域和人口群体的妇幼保健有效覆盖率的影响:我们使用了 2000 年至 2017 年印尼人口与健康调查的四次波次,其中包括 38 880 名 15-49 岁女性和 144 000 份出生记录。主要结果包括产前和分娩护理、剖腹产以及新生儿和婴儿死亡率。我们使用多层次间断时间序列回归法来研究 2014 年 1 月引入 JKN 后的结果变化:JKN 的引入与以下方面的显著增长相关:(1)产前护理(ANC)粗覆盖率(调整 OR (aOR) 1.81,95% CI 1.44 至 2.27);(2)产前护理质量调整覆盖率(aOR 1.66,95% CI 1.38 至 1.98);(3)产前护理质量调整覆盖率(aOR 1.66,95% CI 1.38 至 1.98)。98);(3)ANC 用户依从性调整覆盖率(aOR 1.80,95% CI 1.45 至 2.25);(4)安全分娩服务接触率(aOR 1.83,95% CI 1.42 至 2.36);以及(5)安全分娩粗略覆盖率(aOR 1.45,95% CI 1.20 至 1.75)。我们没有发现产前护理服务接触率或剖腹产率有任何明显的增长。有趣的是,与最富裕人群相比,最贫困人群的产前护理服务接触率和粗覆盖率以及安全分娩粗覆盖率的增幅更大。在实施社会医疗保险后的头 3 年中,没有发现日本医疗保险制度的引入与新生儿和婴儿死亡率之间有统计学意义的关联(P>0.05):社会医疗保险的扩大大大提高了孕产妇医疗服务的质量,但并未降低儿童死亡率。印尼需要共同努力,公平地提高服务质量和儿童死亡率。
Associations between Indonesia's national health insurance, effective coverage in maternal health and neonatal mortality: a multilevel interrupted time-series analysis 2000-2017.
Background: We assessed the effect of Indonesia's national health insurance programme (Jaminan Kesehatan Nasional (JKN)) on effective coverage for maternal and child health across geographical regions and population groups.
Methods: We used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15-49 years and 144 000 birth records. Key outcomes included antenatal and delivery care, caesarean section and neonatal and infant mortality. We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014.
Findings: JKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation.
Interpretation: Expansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.