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Background: Health is a basic human need and a fundamental right of every citizen, as guaranteed by the 1945 Constitution of Indonesia. One of the government's strategic efforts to ensure this right is through the National Health Insurance (JKN) program, managed by BPJS Kesehatan since 2014. This program aims to achieve universal health coverage, improve access, and ensure equity in healthcare services in Indonesia. However, the implementation of this program faces various challenges, such as unequal distribution of healthcare workers, limited infrastructure, and disparities in service quality. Data from the 2023 Indonesia Health Profile and the 2023 Indonesia Health Survey (SKI) show that primary healthcare facilities, such as puskesmas, are the most frequently accessed by the public, although accessibility and service quality remain key issues. According to Anderson's Model, access to healthcare services is influenced by predisposing, enabling, and need factors. This study analyzes the utilization of healthcare services in Indonesia using data from the 2023 SKI, which evaluates trends in access and utilization of healthcare facilities over the past five years. Objective: This study aims to analyze the utilization of healthcare services based on 2023 SKI data. Methods: This study employs a cross-sectional design using secondary data from the 2023 SKI. The study population consists of JKN participants spread across 38 provinces. Analysis was conducted using chi-square tests and simple logistic regression to identify the relationship between the independent variables (predisposing factors: age, gender, education level, and employment status; enabling factors: health insurance ownership, travel time to healthcare facilities, and costs required to access healthcare facilities) and the dependent variable (utilization of healthcare facilities). Results: The study revealed significant relationships between age, gender, education, health insurance ownership, travel time, and costs to access healthcare facilities and the utilization of healthcare services in the past year. Conclusion: There is a significant relationship between predisposing and enabling variables and the utilization of healthcare facilities.
Laporan International Diabetes Federation (IDF) melaporkan prevalensi diabetes melitus di Indonesia pada orang dewasa meningkat setiap tahunnya dan menyebabkan beban biaya kesehatan meningkat. Pelayanan kesehatan di tingkat Fasilitas Kesehatan Tingkat Pertama (FKTP) berfungsi sebagai gatekeeper dalam memberikan layanan promotif, preventif, kuratif, dan rehabilitative diharapkan dapat membantu menekan progresivitas penyakit, mencegah komplikasi, serta mengurangi beban rujukan ke fasilitas kesehatan tingkat lanjutan. Namun, pemanfaatan layanan FKTP masih dihadapkan dengan berbagai tantangan. Penelitian ini bertujuan untuk melihat faktor-faktor yang mempengaruhi layanan kesehatan di FKTP. Penelitian ini menggunakan data sekunder data sampel BPJS Kontekstual DM tahun 2017-2023. Data dianalisis secara univariat, bivariat, dan multivariat menggunakan regresi. Hasil analisis distribusi frekuensi pemanfaatan layanan kesehatan FKTP tahun 2017-2023 didominasi oleh Puskesmas (59,08%). Peserta BPJS dengan segmen peserta Bukan Pekerja, berjenis kelamin perempuan, status perkawinan cerai, lansia (>65tahun), memiliki hak kelas rawat I, dan berdomisili di DKI Jakarta memiliki kemungkinan lebih besar mengunjungi pelayanan FKTP. Faktor segmentasi kepesertaan, jenis kelamin, usia, status perkawinan, hak kelas rawat, dan provinsi FKTP memiliki pengaruh signifikan terhadap penggunaan layanan FKTP oleh peserta JKN dengan DM
The International Diabetes Federation (IDF) report reports that the prevalence of diabetes mellitus in Indonesia in adults increases every year and causes an increase in health costs. Health services at the Primary Health Facility (FKTP) level function as gatekeepers in providing promotive, preventive, curative, and rehabilitative services that are expected to help suppress disease progression, prevent complications, and reduce the burden of referrals to advanced health facilities. However, the use of FKTP services still faces various challenges. This study aims to examine the factors that influence health services at FKTP. This study uses secondary data from the Contextual BPJS DM sample data for 2017- 2023. Data were analyzed univariately, bivariately, and multivariately using regression. The results of the frequency distribution analysis of the use of FKTP health services for 2017-2023 were dominated by Community Health Centers (59.08%). BPJS participants with the Non-Worker participant segment, female, divorced, elderly (>65 years), have class I care rights, and are domiciled in DKI Jakarta are more likely to visit FKTP services. The factors of participant segmentation, gender, age, marital status, class care rights, and FKTP province have a significant influence on the use of FKTP services by JKN participants with DM
Hingga saat ini dari indikator-indikator yang masuk ke dalam komponen pembayaran kapitasi berbasis kinerja yang diinisiasi oleh BPJS Kesehatan, indikator angka kontak menjadi yang pencapaiannya paling rendah dengan capaian nasional kurang dari 50% Puskesmas di Indonesia belum mencapai target angka kontak berdasar data Riset Fasil-itas Kesehatan (Rifaskes) 2019. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh faktor input dan karakteristik dengan ketercapaian angka kontak Puskesmas di Indonesia. Penelitian ini merupakan penelitian analitik dengan menerapkan penelitian kuantitatif dengan pendekatan potong lintang (cross sectional). Sampel dari penelitian ini adalah seluruh Puskesmas yang ada di Indonesia yang masuk dalam Rifaskes 2019 sebanyak 9.831 Puskesmas. Data dalam studi ini diperoleh dari data sekunder yang didapatkan dari hasil Rifaskes 2019. Dari penelitian ini didapatkan dari 5.384 Puskesmas, faktor kelengkapan alat kesehatan esensial poliklinik (OR=1,16; p=0,029), rasio dokter per 5000 peserta (OR=1,06; p<0,0001), rasio bidan per 5000 peserta (OR=1,01; p=0,033), dan pengelolaan keuangan berbasis BLUD (OR=1,13; p=0,062) secara signifikan memengaruhi ketercapaian angka kontak. Namun, model prediktif hanya menjelaskan 2,6% varians (Nagelkerke R²=0,026). Pada penelitian berikutnya dapat dilakukan perampingan data dan mengambil studi menilai pengaruh dari faktor-faktor lain seperti output Puskesmas atau demand dari sisi pasien. Diharapkan pihak berwenang dapat melengkapi alat kesehatan dan menambah tenaga kesehatan di Puseksmas guna meningkatkan angka kontak.
Of the indicators included in the performance-based capitation payment component in-itiated by BPJS Kesehatan, the contact rate indicator has the lowest achievement. Based on 2019 Riset Fasilitas Kesehatan (Rifaskes) data, less than 50% of Puskesmas in Indonesia did not reach the contact rate target. This study aimed to determine the effect of input and characteristics factors on contact rate achievement among Pusk-esmas in Indonesia. This analytical study applied a quantitative research design and used cross-sectional approach. The study sample included all 9,831 Puskesmas in In-donesia included in the 2019 Rifaskes. Data for this study were using secondary data obtained from the 2019 Rifaskes results. The study found that the completeness of es-sential medical equipment for polyclinics (OR = 1.16; p = 0.029), the ratio of doctors to 5,000 participants (OR = 1.06; p < 0.0001), the ratio of midwives to 5,000 partici-pants (OR = 1.01; p = 0.033), and BLUD-based financial management (OR = 1.13; p = 0.062) significantly influenced contact rate achievement. However, the predictive model only explained 2.6% of the variance (Nagelkerke R² = 0.026). Future research could refine the data and examine the influence of other factors, such as output factors or patient demand. It is expected that authorities should equip Puskesmas with medical equipment and increase the number of health workers to improve contact rates.
