Implementasi program Jaminan Kesehatan Nasional (JKN) sejak tahun 2014 menghadapi tantangan dalam pengelolaan layanan hemodialisis sebagai terapi utama gagal ginjal kronik. Penelitian bertujuan menganalisis pola pemanfaatan layanan hemodialisis dalam konteks Rawat Jalan Tingkat Lanjut (RJTL) oleh peserta JKN. Penelitian cross sectional ini menggunakan data klaim BPJS Kesehatan tahun 2023 dengan sampel 81.816 peserta. Analisis data meliputi univariat, bivariat, dan multivariat menggunakan regresi binomial negatif. Hasil menunjukkan rata-rata kunjungan hemodialisis nasional mencapai 51,46 kali per tahun. Peserta Non-PBI memiliki tingkat pemanfaatan 13,6% lebih tinggi dibanding PBI (IRR=1,136; p<0,000). DI Yogyakarta mencatatkan rata-rata kunjungan tertinggi (61,78 kali/tahun), sementara Papua terendah (18,06 kali/tahun). Fasilitas TNI AU menunjukkan rata-rata kunjungan tertinggi (72,79 kali/tahun). Kesimpulan menunjukkan adanya kesenjangan signifikan dalam pemanfaatan layanan hemodialisis berdasarkan karakteristik demografis, geografis, dan kepemilikan fasilitas kesehatan. Diperlukan pengembangan kebijakan komprehensif untuk meningkatkan akses dan pemerataan layanan hemodialisis bagi seluruh peserta JKN.

The implementation of the National Health Insurance (JKN) program since 2014 has faced various challenges in managing hemodialysis services as the primary modality for chronic kidney disease therapy. This study aims to analyze the utilization patterns of hemodialysis services in the context of Advanced Outpatient Care (RJTL) by JKN participants and identify factors influencing service utilization. This study with a cross-sectional design used secondary data from BPJS Kesehatan claims in 2023. The study population comprised all JKN participants undergoing hemodialysis, with a sample size of 81,816 participants. Data analysis was conducted comprehensively, including univariate, bivariate, and multivariate analyses using negative binomial regression models. The analysis results showed that the national average of hemodialysis visits reached 51.46 times per year. There were significant variations in service utilization based on membership segmentation, where Non-PBI participants showed 13.6% higher utilization rates compared to PBI participants (IRR=1.136; p<0.000). Regional analysis revealed that DI Yogyakarta recorded the highest average visits at 61.78 times per year, while Papua recorded the lowest average with 18.06 visits. In terms of healthcare facility ownership, Air Force facilities showed the highest average visits at 72.79 times per year. Research findings indicate significant disparities in hemodialysis service utilization based on demographic, geographic, and healthcare facility ownership characteristics. These results emphasize the importance of developing comprehensive policies to improve access and equitable distribution of hemodialysis services for all JKN participants.