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. 2024 Feb 21;25(1):64.
doi: 10.1186/s12875-024-02296-6.

What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia

Afina Nur Fauziyyah  1   2 , Akira Shibanuma  1 , Ken Ing Cherng Ong  3 , Masamine Jimba  1
Affiliations

What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia

Afina Nur Fauziyyah et al. BMC Prim Care. .

Abstract

Background: Ensuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries' primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia.

Methods: The setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants' choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses.

Results: BPJS-Health partners' geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners' services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities.

Conclusions: Sociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants' primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners' coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.

Keywords: Choice; Health insurance; Preference; Primary care; Spatial network analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overview of the study process. BPJS-Health partners: Primary care providers in partnership with Badan Penyelenggara Jaminan Sosial Kesehatan (Indonesian National Health Insurance provider)
Fig. 2
Fig. 2
Geographical coverage map of BPJS-Health and non-BPJS-Health partners. BPJS-Health partners : Primary care providers in partnership with BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan–Indonesian National Health Insurance)
Fig. 3
Fig. 3
Sampling areas for household-based survey. BPJS-Health partners : Primary care providers in partnership with BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan–Indonesian National Health Insurance)
Fig. 4
Fig. 4
Residents’ health service utilization (n=213). BPJS-Health : Badan Penyelenggara Jaminan Sosial Kesehatan (Indonesian National Health Insurance)
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