ABSTRACT

 Uterine cervical cancer is still a public health problem in Indonesia with incidence rate of 12.6 / 100,000 women and mortality rate 7.0 / 100,000 women. (IARC, 2008). Indonesian mortality rate is still high due to the risk factors that have not been handled in community. Multi parity (especially parity > 4) or total of women giving birth as a risk factor for uterine cervical cancer was still high. This study aims to determine the effect of parity > 4 to uterine cervical cancer. The study design is a hospital-based case-control, which samples were taken from 6 hospitals and then matched by hospital and age interval of 10 years. Multivariate analysis using conditional logistic regression shows the parity > 4 increases the risk of uterine cervical cancer OR: 1.85, CI 95% (1.14 -3.02). Therefore, efforts to develop programs that can limit births as family planning program will help reduce the occurrence of cases of cervix uteri.

Peningkatan angka harapan hidup dan beban penyakit kronis pada populasi pensiunan menimbulkan tantangan signifikan terhadap keberlanjutan pembiayaan layanan kesehatan pensiunan Perusahaan X. Penelitian ini bertujuan untuk menganalisis keberlanjutan finansial layanan kesehatan pensiunan selama periode 2025–2029 serta merumuskan strategi keberlanjutan yang dapat diterapkan oleh Perusahaan X. Penelitian ini menggunakan desain deskriptif komparatif non-eksperimental dengan pendekatan proyeksi populasi berdasarkan Age-Specific Death Rate (ASDR), proyeksi 28 penyakit biaya tertinggi menggunakan age specific prevalence rate, serta estimasi biaya berdasarkan beban penyakit per kelompok usia. Analisis keberlanjutan dilakukan dengan membandingkan estimasi biaya dan anggaran tahunan. Hasil menunjukkan bahwa terjadi peningkatan rata-rata usia kematian, penuaan populasi, serta tren pertumbuhan populasi yang negatif. Dari 28 penyakit utama, 21 menunjukkan peningkatan kasus, dan rasio biaya pada kelompok usia ≥70 tahun dua kali lipat lebih tinggi dibandingkan kelompok usia <56 tahun. Tanpa intervensi, sistem diproyeksikan mengalami defisit pada tahun 2028. Strategi yang paling efektif meliputi peningkatan anggaran minimal 12,5% per tahun, efisiensi hasil negosiasi dengan provider sebesar 10%, integrasi dengan JKN, serta penguatan program promotif dan preventif berbasis komunitas. Meskipun skema deductible sebesar Rp75.000 dinilai efisien secara teknis, pendekatan ini kurang direkomendasikan secara sosial. Program skrining penyakit ginjal kronis memberikan efisiensi 1-2,35% dari total biaya. Disimpulkan bahwa tanpa intervensi, sistem pembiayaan tidak berkelanjutan, dan diperlukan strategi terintegrasi untuk mencegah defisit pada tahun 2028. Oleh karena itu, direkomendasikan agar Perusahaan X melakukan intervensi berbasis data dengan mempertimbangkan kepentingan penjamin, peserta dan provider  demi keberlangsungan sistem layanan kesehatan pensiunan di masa depan.

The increase in life expectancy and the burden of non-communicable diseases among retirees posed significant challenges to the financial sustainability of the retiree healthcare system of Company X. This study aimed to analyze the financial sustainability of healthcare services for retirees over the 2025–2029 period and to formulate appropriate sustainability strategies for Company X. A non-experimental descriptive-comparative design was employed using population projections based on Age-Specific Death Rates (ASDR), the projection of the 28 highest-cost diseases was conducted using age-specific prevalence rates, and cost projection based on cost per person by disease and age group. Financial sustainability analysis involves comparing estimated costs with projected annual budgets. The findings indicated an increase in average age at death, population aging, and a negative population growth trend. Among 28 major diseases analyzed, 21 showed increasing cases, and the cost ratio for individuals aged ≥70 was 2x higher than for those aged <56. Without intervention, the healthcare financing system was projected to experience a deficit by 2028. The most effective strategies included a minimum annual budget increase by 12.5%, a 10% discount from provider payment based on negotiation, integration with the National Health Insurance (JKN), and strengthening community-based health promotion and prevention programs. Although a deductible scheme of IDR 75,000 was technically efficient, it was not socially recommended. The implementation of the chronic kidney disease screening program resulted in a cost efficiency of 1–2.35% of the total healthcare expenditure. In conclusion, without intervention, the system would be financially unsustainable. Therefore, it is recommended that Company X implement data-driven sustainability strategies that balance the interests of payers, beneficiaries, and providers to ensure the long-term sustainability of retiree healthcare services.