Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;3(1):e160.
doi: 10.52225/narraj.v3i1.160. Epub 2023 Apr 30.

Implementation of Aceh Health Insurance (Jaminan Kesehatan Aceh) 2013-2021: Has health equity been achieved for all Acehnese after armed conflict?

Muhammad Yani  1 , Mahlil Ruby  2 , Diah A Puspandari  3 , Munawar Munawar  4 , Kamal Fachrurrozi  5 , Isfanda Isfanda  6 , Aditya Candra  6 , Teuku M Ilzana  7 , Teuku M Khaled  8   9 , Cut R Rahmi  10
Affiliations

Implementation of Aceh Health Insurance (Jaminan Kesehatan Aceh) 2013-2021: Has health equity been achieved for all Acehnese after armed conflict?

Muhammad Yani et al. Narra J. 2023 Apr.

Abstract

Aceh Health Insurance (Jaminan Kesehatan Aceh-JKA) has been implemented since 2010 to increase the health equity by covering the health expenses and guaranteeing that all Acehnese are covered regardless of their economic, educational, and social statuses. However, since its implementation, there has been no study on its impact on health quality, particularly regarding the utilization of the main referral hospital (Dr Zainoel Abidin Hospital located in Banda Aceh) and the effects of the geographic accessibility and the number of specialist doctors in each regency/city on hospital utilization. This retrospective study assessed the equity factors during the Aceh Health Insurance implementation and during its integration to National Health Insurance (Jaminan Kesehatan Nasional-JKN) from 2013 to 2021 using data of travel time (time spent for travelling from the origin regency/city of referred patients to the main referral center) and healthcare resources (number of specialist doctors). The data were analyzed using Student's t-tests, Kolmogorov-Smirnov or Mann-Whitney U test when appropriate. Williamson Index was calculated to determine the disparities of health equity between regencies. Our data indicated the noticeably increase of health facilities utilization since the implantation of Aceh Health Insurance. However, there was no equity in the use of main referral facility by the residents in Aceh - was dominated by residents who lived closer and from more populated regencies/cities. In conclusion, there are accessibility and financial hardship barriers in accessing the health care facilities during the implementation of Aceh Health Insurance that need to be addressed by the government to achieve the health equity for all Acehnese.

Keywords: Aceh; JKA; JKN; Universal health coverage; health equity.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.. Utilization of JKA by inpatients and outpatients in Aceh main referral center (Dr Zainoel Abidin Hospital) from 2016 to 2021. The utilization is calculated by dividing the number patients (inpatients or outpatients) by total number of JKA memberships and multiplying by a thousand.
Figure 2.
Figure 2.. Number of inpatients and outpatients in Aceh main referral facility by health insurance participants during 2016-2021.
Figure 3.
Figure 3.. Correlation between hospital utilization and number of specialists between 2017–2021.
Figure 4.
Figure 4.. Disparities of the number of specialist doctors against the population by regency/city.
See this image and copyright information in PMC

References

    1. WHO. Tracking Universal health coverage: First global monitoring report. France: World Health Organization. 2015.
    1. Heger MP, Neumayer E.. Economic legacy effects of armed conflict: Insights from the civil war in Aceh, Indonesia. Confl Manag Peace Sci 2022; 39(4):394–421.
    1. Dinas Kesehatan Provinsi Aceh. Profil kesehatan Aceh tahun 2020. Dinas Kesehatan Provinsi Aceh. 2021.
    1. Al-Taiar A, Clark A, Longenecker JC, et al. . Physical accessibility and utilization of health services in Yemen. Int J Health Geograph 2010; 9(1):38. - PMC - PubMed
    1. Feikin DR, Nguyen LM, Adazu K, et al. . The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Trop Med Int Health 2009; 14(1):54–61. - PubMed

LinkOut - more resources