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Chronic Kidney Disease (CKD) poses a significant financial burden, making the utilization of Advanced Outpatient Services (AOS) crucial, especially for National Health Insurance (JKN) participants. This cross sectional study involved 498 CKD patients who used AOS in 2023. The results showed that age, sex, marital status, membership segmentation, class of care entitlement, and facility ownership were significantly associated with AOS utilization (p<0.05). Age ≥65 years was the most dominant factor (AOR: 1.48; 95% CI: 1.29–1.69). All variables had a significant influence on the utilization of AOS among CKD patients.
Background: Mental health disorders present a significant global economic burden, with projected losses reaching USD 6 trillion by 2030. In Indonesia, the estimated annual direct cost may reach IDR 87.5 trillion if all individuals with mental disorders undergo routine treatment. Objective: To identify the total cost and factors associated with mental health service expenditures in outpatient care at advanced referral health facilities (FKRTL) for JKN participants. Methods: This study uses cross-sectional design using the 2024 BPJS Kesehatan Sample Data. Univariate and bivariate analyses were conducted on 785,150 active mental health service users. Results: BPJS Kesehatan covered a total of IDR 3.4 trillion in mental health outpatient services within one year. There was a significant relationship between service costs and age, participant segmentation, number of diagnoses, outpatient visits frequency, advanced health facilities regional, advanced referral health facilities ownership, and chronic disease conditions. Conclusions: The highest costs were observed among the elderly and in Regional 1, reflecting a concentration of services and better access. These findings highlight the importance of equitable distribution and need-based approaches in mental health service financing.
Latar Belakang: Skizofrenia merupakan gangguan mental kronis yang menimbulkan beban signifikan terhadap sistem pembiayaan kesehatan, terutama dalam program Jaminan Kesehatan Nasional (JKN). Penyakit ini memerlukan perawatan jangka panjang dan rawan kekambuhan, sehingga berkontribusi terhadap tingginya angka kunjungan dan pembiayaan di fasilitas kesehatan, khususnya pada layanan rujukan. Tujuan: Mengetahui besarnya biaya pelayanan kesehatan peserta JKN dengan skizofrenia dan faktor-faktor yang berhubungan dengan biaya tersebut. Metode: Penelitian kuantitatif dengan desain cross-sectional menggunakan data sekunder BPJS Kesehatan tahun 2024. Sampel terdiri dari 1.597 peserta aktif JKN dengan diagnosis skizofrenia selama satu tahun. Analisis dilakukan secara univariat dan bivariat menggunakan SPSS versi 25. Hasil: Total biaya pelayanan mencapai Rp16.896.391.354. Rata-rata biaya rawat jalan Rp314.929 dan rawat inap Rp5.050.107. Biaya signifikan dipengaruhi oleh usia, hubungan keluarga, kelas hak rawat, segmentasi peserta, wilayah kepesertaan, jenis dan kepemilikan FKTP/FKRTL, kunjungan ke FKTP, dan tipe FKRTL. Kesimpulan: Skizofrenia memberikan beban biaya tinggi pada JKN. Diperlukan pembiayaan berbasis kebutuhan serta penguatan layanan jiwa di tingkat primer dan komunitas untuk efisiensi sistem.
Background: Schizophrenia is a chronic mental disorder that poses a significant burden on the healthcare financing system, particularly within Indonesia’s National Health Insurance (JKN) program. The condition requires longterm care and is prone to relapse, contributing to high healthcare utilization and costs, especially at referral level facilities. Objective: To determine the total healthcare costs for JKN participants diagnosed with schizophrenia and to identify factors associated with those costs. Methods: This quantitative study employed a crosssectional design using secondary data from BPJS Kesehatan (Indonesia’s Social Health Insurance) for the year 2024. The sample consisted of 1.597 active JKN participants diagnosed with schizophrenia over a 12 month period. Data were analyzed using univariate and bivariate techniques in SPSS version 25. Results: The total healthcare cost amounted to IDR 16.896.391.354. The average outpatient cost was IDR 314.929, while the average inpatient cost was IDR 5.050.107. Factors significantly associated with higher costs included age, family relationship status, treatment class, participant segmentation, region of enrollment, type and ownership of primary and referral healthcare facilities (FKTP/FKRTL), number of visits to primary care, and type of referral facility. Conclusion: Schizophrenia places a substantial financial burden on the JKN system. A need-based financing approach and strengthened mental health services at the primary and community levels are essential to improving efficiency and sustainability.
Penyakit Paru Obstruktif Kronik (PPOK) merupakan penyebab kematian keempat tertinggi di dunia, dengan total sekitar 3,5 juta kematian pada tahun 2021 menurut data WHO. Jumlah ini setara dengan 5% dari seluruh kematian global. Di Indonesia, PPOK termasuk dalam 20 besar penyakit dengan kunjungan rawat jalan tingkat lanjut (RJTL) terbanyak berdasarkan ICD selama delapan tahun terakhir, dari 2017 hingga 2024. Mengingat PPOK adalah penyakit kronis yang membutuhkan penanganan jangka panjang dan stabil, integrasi layanan primer dan lanjutan menjadi kunci keberhasilan pengelolaannya. Penelitian ini bertujuan untuk mengetahui pola pemanfaatan layanan kesehatan tingkat primer dan lanjutan oleh peserta Jaminan Kesehatan Nasional (JKN) yang menderita PPOK di Indonesia, serta faktor-faktor yang memengaruhinya berdasarkan karakteristik predisposisi, kemampuan, dan sistem pelayanan kesehatan. Desain penelitian ini adalah kuantitatif dengan pendekatan cross-sectional menggunakan Data Sampel BPJS Kesehatan tahun 2024. Total sampel yang dianalisis adalah 5.281 sebelum pembobotan. Analisis data dilakukan menggunakan tabulasi silang, uji chi-square, dan regresi logistik multinomial. Hasil penelitian menunjukkan bahwa pemanfaatan layanan kesehatan oleh penderita PPOK didominasi oleh layanan tingkat primer (73,3%). Pemanfaatan layanan tingkat lanjut saja lebih tinggi (16%) dibandingkan dengan integrasi layanan primer dan lanjutan (10,6%). Ditemukan bahwa karakteristik predisposisi, kemampuan, dan sistem pelayanan kesehatan berhubungan secara signifikan dengan pola pemanfaatan layanan kesehatan tingkat primer dan lanjutan pada penderita PPOK di Indonesia. Temuan ini menekankan pentingnya penguatan pelayanan penapisan dan program rujuk balik (PRB), penerapan pendekatan pelayanan yang holistik, serta integrasi yang lebih kuat antara layanan primer dan lanjutan untuk meningkatkan efektivitas penatalaksanaan PPOK.
Kata kunci: Penyakit paru obstruktif kronik (PPOK), Utilisasi Pelayanan Kesehatan, Jaminan Kesehatan Nasional (JKN), Data Sampel BPJS Kesehatan
Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death globally, with approximately 3.5 million deaths reported in 2021, according to WHO data. This figure accounts for around 5% of all global deaths. In Indonesia, COPD has consistently ranked among the top 20 diseases with the highest number of advanced outpatient visits (RJTL) based on ICD data from 2017 to 2024. Given that COPD is a chronic condition requiring long-term and stable management, integration between primary care services and advanced care services is essential to ensure comprehensive disease management. This study aims to examine the pattern of primary and advanced healthcare service utilization among participants of the National Health Insurance (JKN) who suffer from COPD in Indonesia, and to identify influencing factors based on predisposing characteristics, enabling resources, and the healthcare system. The research used a quantitative cross-sectional design, utilizing the 2024 Sample Data from BPJS Kesehatan. A total of 5,281 samples were analyzed prior to weighting. Data analysis was conducted using cross-tabulation, chi-square tests, and multinomial logistic regression. The findings reveal that healthcare service utilization by COPD patients is predominantly at the primary care level (73.3%). The utilization of advanced care services alone (16%) was higher than the integrated healthcare services (10.6%). It was also found that predisposing characteristics, enabling factors, and the healthcare system were significantly associated with the pattern of healthcare utilization among COPD patients in Indonesia. These findings highlight the importance of strengthening early diagnostic capacity for COPD at primary healthcare facilities, implementing a holistic service approach, and enhancing integration between primary and advanced care to improve the effectiveness of COPD management. These findings highlight the importance of strengthening screening services and the Back Referral Program (PRB), implementing a holistic approach to care, and fostering stronger integration between primary and secondary care services to enhance the effectiveness of COPD management.
This study aims to analyze the use of caesarean section deliveries in advanced referral health facilities in DKI Jakarta Province in 2023, using an non-experimental analytical cross-sectional design based on BPJS Health sample data from 2024. Results showed that 77.6% of participants gave birth via caesarean section. Several factors were significantly associated with caesarean delivery, including age over 35 years (OR: 1.93; 95% CI: 1.68–2.21), residence in East Jakarta (OR: 4.68; 95% CI: 4.18–5.25), PBPU insurance status (OR: 2.50; 95% CI: 2.23–2.79), Class I inpatient entitlement, private hospital ownership (OR: 3.19; 95% CI: 3.08–3.32), Class C hospital type (OR: 1.50; 95% CI: 1.47–1.75), and facility location in East Jakarta (OR: 3.75; 95% CI: 3.53–3.98). History of caesarean section was the strongest predictor (OR: 77.2; 95% CI: 61.42–97.2), indicating a high likelihood of reccuring procedures. These findings highlight the importance of careful medical decision-making during the first delivery, as it can significantly influence subsequent delivery patterns. Comprehensive interventions are needed, both on the maternal side through preventive measures and strengthened readiness starting at the primary care level, and on the service side through medical audits and strict implementation of clinical guidelines.
This study aims to determine the factors related to the utilization of advanced inpatient care (RITL) in FKRTL by JKN participants in the North Sulawesi Province in the year both before the COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). This research is quantitative with a cross-sectional study design using secondary data in the form of BPJS Health Sample Data 2019-2020. The sample obtained came from the total sampling method, so that samples that meet the inclusion and exclusion criteria will be included. The total sample obtained in 2019 was 24,748, while the total sample obtained in 2020 was 25,902 participants. The relationship test was analyzed through the Single Logistic Regression test. The results of the study show that overall there is a decrease in inpatient utilization after the COVID-19 pandemic compared to before the COVID-19 pandemic. RITL services both before the COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020) were widely accessed by participants in the elderly group (7.39% and 4.13%), women (6.49% and 4. 46%), the group of participants with divorced status (12.16% and 6.58%), the group of wives (7.44% and 6.06%), the group of participants with a history of PM and PTM (11.36% and 7, 78%), the right to care class I (7.67% and 6.54%), the PBPU segmentation group (9.66% and 8.53%), the group who had accessed outpatient care in FKTP (9.09% and 5.89%) and FKRTL (17.51% and 10.85%), participants registered in clinic type FKTP (8.04% and 6.64%), participants registered in privately owned FKTP (7.19% and 5.84%, and the group of participants who live in cities (6.03% and 4.20%). All variables have a significant relationship with RITL utilization both before the COVID-19 pandemic or during the COVID-19 pandemic.