Indonesian Journal of Health Administration
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THE ROLE OF PRENATAL CLASSES IN EXCLUSIVE BREASTFEEDING: EVIDENCE FROM PAPUA, INDONESIA
Full text linkBackground: Exclusive breastfeeding (EBF) is a lifesaving practice for infants in vulnerable conditions. Therefore, it is crucial to ensure the optimization of EBF coverage in disadvantaged areas. One of the barriers to EBF is limited maternal knowledge, and prenatal classes are designed to improve maternal health knowledge and practices.
Aims: The study aimed to analyze the role of prenatal classes in supporting EBF in Papua.
Methods: The cross-sectional study examined 640 mothers with children aged 0-5 months from the Papua Region. Prenatal classes were an exposure variable, while EBF practice served as an outcome variable. Nine control variables, including age, marital status, education, work, wealth, sex, infant age, and early initiation of breastfeeding (EIBF), were incorporated into the analysis. Binary logistic regression test was used for analysis.
Results: The proportion of EBF in Papua is 50.7%. Mothers who participated in prenatal classes were 1.560 times more likely to practice EBF than those who did not (AOR = 1.560; 95% CI [1.476-1.649]). Additionally, the study identified nine control variables related to EBF in the Papua Region: type of residence, maternal age group, maternal marital status, education level, employment status, wealth status, infant age, infant sex, and EIBF.
Conclusion: Participation in prenatal classes is positively associated with the achievement of EBF practice in the Papua Region. Additional characteristics associated with a higher likelihood of EBF among Papuan mothers included having a higher level of education and employment, living in rural regions, experiencing poverty, being married, and achieving successful EIBF.
Keywords: exclusive breastfeeding, Papua, prenatal classes, public health, public health nutritio
HETEROGENEITY OF JKN-PBI’S IMPACT ON HOUSEHOLD OUT-OF-POCKET HEALTH EXPENDITURES IN INDONESIA
No full textBackground: The National Health Insurance-Contribution Assistance Recipients (JKN-PBI) participants in Indonesia tended to increase. However, out-of-pocket (OOP) health expenditures among participants did not significantly decrease. This phenomenon may have occurred because the impact of this program on OOP health expenditures varied by household group.
Aims: This study investigated the heterogeneity impact of the JKN-PBI program across per capita expenditure quartiles and residential regions in 2024.
Methods: The study used data from BPS-Statistics Indonesia. Because the determination of JKN-PBI program recipients was endogenous, this study used the Inverse Propensity Score Weighting (IPW) model. Tobit regression was also applied to accommodate the OOP health expenditure reported as a zero value.
Results: Participation in JKN-PBI significantly reduced OOP health expenditures. More nominal reductions occurred in higher quartiles, whereas proportional reductions occurred in lower quartiles. This outcome indicated that households in the lower quartiles obtained greater health service advantages relative to households in the higher quartiles. The reduction in OOP health expenditure share was also greater in rural areas.
Conclusion: The government must prioritize this program in rural regions and low-income households. In addition, the government needs to identify healthcare service needs by regions and income groups so that the use of the JKN-PBI card is more optimal.
Keywords: National Health Insurance Program, Out-of-Pocket Expenditure, Heterogeneous Impact, Inverse Propensity Score Weighting, Tobit Regressio
THE APPLICATION OF STANDARDIZED HEALTH SERVICE FEES IN THE HEALTH INSURANCE SCHEME
Full text linkBackground: The implementation of the Indonesian Minister of Health Regulations No. 3 of 2023 on the standard health service tariff in the national health insurance program, as a replacement for the previous policy, has created confusion among field implementers. The capitation rate is considered sufficient but is sometimes insufficient to cover Public Health Care (PHC) operational costs.
Aims: This study aims to analyze standard health service tariffs in the implementation of the health insurance program at PHCs.
Methods: The authors used descriptive qualitative methods with a case study as the research design. The unit of analysis was the health service tariff standards at the PHCs. Data collection techniques involved snowball discussions followed by FGDs. Research subjects were selected using a purposive sampling technique. The FGDs consisted of 3 participants from BPJS Kesehatan, 4 from the public health centers, 2 people from private clinics, and 3 individual practitioner doctors. Data were analyzed using Open Code software. In addition, a policy analysis of PHC tariff standards was also conducted.
Results: PHCs have implemented the Minister of Health Regulations No. 3 of 2023 since February 2023. In the implementation of health service tariff standards at the PHCs, no significant obstacles were encountered, as they adjusted to the applicable policies. Although the tariff standards follow Minister of Health Regulations No.3 of 2023 and include an increase in the capitation value compared to the previous policy, the amount is perceived as inadequate and still below the reasonable cost required for service delivery. Private clinics and individual practitioners must still cover operational expenses using capitation funds supplemented by income from non-insured patients to meet operational costs related to human resources, equipment, and supporting facilities.
Conclusion: PHCs have implemented the standard health service tariff in accordance with the existing policy. However, the increase in capitation fees has not fully covered the costs at PHCs.
Keywords: health service; PHC; tariff standar
THE COST OF TREATMENT FOR PEDIATRIC TUBERCULOSIS PATIENTS: A CROSS-SECTIONAL STUDY
Full text linkBackground: Tuberculosis (TB) is a leading global communicable disease. Pediatric tuberculosis, in particular, is prevalent among the population aged 0-14 years and necessitates a treatment duration of at least six months.
Aims: This study aims to assess the total treatment cost of pediatric tuberculosis patients and determine the factors associated with the total cost.
Methods: A cross-sectional design was employed to collect the retrospective data at a public hospital and PHC in the province-level Special Region of Yogyakarta, Indonesia. Treatment costs are categorized into the following: laboratory costs, professional costs, drug costs, medical and non-medical support costs, and miscellaneous costs. The collected data underwent both descriptive and statistical analysis using regression methods, namely logistic and probit regressions.
Results: The analysis revealed that most patients were between 0 and 2 years old and most of them are school-age, with an average treatment cost of USD 62.80 per patient. The study identified laboratory costs (RR 0.198; 95% CI 0.083-0.314), professional costs (RR 9.402; 95% CI 4.108-14.698), drug costs (RR 5.269; 95% CI 2.326-8.212), and medical support costs (RR 0.223;95% CI 0.064-0.382) as the primary contributors to the total cost.
Conclusion: The point of this study is that effective treatment is possible with proper financial support. To achieve a successful outcome in treating pediatric tuberculosis, it is imperative to establish an advocacy and collaboration effort to enhance the primary health services. This cooperative effort should prioritize convenient access to treatment and enhancing active case finding.
Keywords: cost of illness, cost of treatment, pediatric tuberculosi
SOSIODEMOGRAPHIC DETERMINANTS OF HEALTH FACILITY UTILIZATION IN INDONESIA: Determinan Sosiodemografi Utilisasi Pelayanan Kesehatan di Indonesia
Full text linkBackground: Health service facility utilization is crucial for determining healthcare service success and accessibility. Sociodemographic factors significantly influence utilization patterns.
Aims: This research aims to examine the relationship between sociodemographic factors and health facility utilization patterns among the Indonesian population
Methods: Secondary data from the 2023 Indonesian Health Survey (Health Development Policy Agency, Ministry of Health) were analyzed using a quantitative cross-sectional approach. Chi-square tests and binary logistic regression were employed for bivariate and multivariate analyses
Results: Non-JKN health insurance was the dominant factor with PR = 2.4 (95%CI PR: 2.335-2.645), followed by never in union with PR= 1.328 (95%CI PR:1.269-1.390). Married with PR= 1.3 (95%CI PR: 1.224-1.381), unemployed with PR= 1.262 (95%CI PR: 1.226-1.300), children with PR= 1.181 (95%CI PR: 1.110-1.257), men with PR =1.030 (95% CI PR: 1.005-1.005). Factors reducing utilization likelihood included are rural residence with PR= 0.378 (95%CI PR: 0.368-0.388), secondary education with PR= 0.390 (95%CI PR: 0.376-0.404), adult with PR= 0.650 (95%CI PR: 0.603-0.701), primary education with PR= 0.703 (95%CI PR: 0.684-0.722), non formal occupation with PR= 0.955 (95%CI PR: 0.922-0.989).
Conclusion: The binary logistics regression shows that health insurance ownership is the most dominant predictor, with individuals holding non-JKN health insurance being 2.4 times more likely to utilize healthcare services compared to those with JKN insurance. Therefore, geographical disparities and educational levels are critical obstacles that require intervention in efforts to improve access to health services.
Keywords: Determinants, Health Facility, Sociodemographic, Utilization, SKI 202
INTERPROFESSIONAL COLLABORATION FOR PATIENT SATISFACTION IN INDONESIA
Full text linkBackground: One of the ways to improve healthcare quality in hospitals is patient-centered care (PCC). In improving patient-centered care, health workers can optimize interprofessional collaboration (IPC), but it remains challenging to understand how they communicate and coordinate, and thus, the impact of IPC on patient satisfaction remains unclear.
Aims: It aimed to investigate the impact of IPC implementation on patient satisfaction within the PCC in a teaching hospital.
Methods: A mixed-methods design was employed in this study, comprising 140 samples, consisting of 70 healthcare providers (IPC measured by AITCS-II) and 70 patients (satisfaction assessed using a modified SERVQUAL) for the quantitative component. Chi-square and multivariate logistic regression were used to analyze the data. The respondents, three healthcare professionals and three patients, were then interviewed to share their experiences with IPC and patients’ satisfaction. The data were then analyzed by using grounded theory (open, axial, and selective coding).
Results: Interprofessional collaboration was reported to improve patient satisfaction (p = 0.016). The indicators that significantly increased the patients' satisfaction are partnership, cooperation, and coordination, with adjusted odds ratios (aORs) of 2.05, 1.80, and 1.72, respectively. These results, then, are in line with the qualitative findings, which reported that the barriers to implementing IPC include communication, teamwork, and hierarchy.
Conclusion: It can be concluded that IPC can affect patient satisfaction in PCC implementation
Keywords: Health Services Administration, Interprofessional Relations, Patient-Centered Care, Patient Satisfaction, Teaching Hospital
IMPROVING PATIENT SAFETY CULTURE (PSC) IN PRIMARY HEALTH CENTERS IN JAMBI PROVINCE
No full textBackground: Patient safety incidents continue to occur in primary health care services despite being 24% to 85% preventable. Promoting and assessing patient safety culture is the primary step to minimize and prevent adverse incidents.
Aims: This research examined the level of patient safety culture implementation in Primary Health Centers.
Methods: A quantitative descriptive research design was conducted involving 319 employees randomly selected from 11 Primary Health Centers in Jambi province. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire and analyzed descriptively, with an average cut-off point of 75%.
Results: The implementation level of patient safety culture in the Primary Health Centers in Jambi Province was 71.5%. Furthermore, seven dimensions of patient safety culture were weakly implemented: staffing, communication openness, organizational learning for continuous improvement, supervisor/manager expectations and actions promoting patients, non-punitive response to error, general perception of patient safety, and frequency of error reporting.
Conclusion: Continuous examination should be conducted to ensure better changes in improving patient safety culture.
Keywords: Jambi Province, Patient safety culture, Primary health cente
SYSTEMATIC LITERATURE REVIEW: EXCLUSIVE BREASTFEEDING AND STUNTING – A PREVENTIVE APPROACH FOR HEALTH POLICY
Full text linkBackground: Stunting negatively impacts children’s growth, cognitive development, and future productivity. A frequently overlooked yet critical risk factor is the absence of exclusive breastfeeding (EBF). Many studies continue to explore and update the critical role and the urgency of EBF.
Aims: This research aimed to identify and analyze the previous studies on the relationship between EBF and stunting to capture a comprehensive understanding of EBF’s role in stunting prevention and various associated factors.
Methods: A Systematic Literature Review with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) protocol was employed through four steps – identification, screening, inclusion, and eligibility. A total of 865 articles were initially retrieved from electronic databases (Google Scholar and PubMed). Following the inclusion and exclusion criteria, 18 studies resulted in the final review.
Results: There was a significant relationship between EBF and stunting incidents. Key contributing barriers are predominantly observed in families with low socioeconomic status and limited educational attainment. In addition, prevailing public perceptions and traditional cultural practices—such as pre-lacteal feeding and CF-were also identified as influential factors.
Conclusion: The failure to practice EBF contributes to increased stunting, primarily due to the absence of optimal nutrition and immune protection provided by breast milk. The ignorance of EBF stems from customs and culture that have been applied from era to era. Addressing this issue requires multidimensional interventions, particularly focusing on educational and environmental support. Future research should adopt a multi-sectoral approach to inform evidence-based policy-making for more effective stunting prevention.
Keywords: Children aged under 5 years, chronic nutrition, exclusive breastfeeding, stunting, systematic literature review.
PRIVATE HEALTH INSURANCE OWNERSHIP IN A SOCIAL HEALTH INSURANCE DOMINATED SYSTEM
Full text linkBackground: Private health insurance coverage in Indonesia remains very limited, which may increase financial vulnerability despite the dominance of social health insurance.
Aims: This study examines factors associated with private health insurance ownership among the Indonesian population.
Methods: A cross-sectional study was conducted using data from the 2023 National Socio-Economic Survey (SUSENAS), including 179,339 respondents aged 15–64 years. Multiple logistic regression was applied to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals, controlling for demographic, socioeconomic, and health-related factors
Results: The prevalence of private health insurance ownership was 0.5%. Higher education, married status, rich economic status, exposure to internet media, and absence of health complaints were significantly associated with a higher likelihood of ownership. In contrast, respondents aged 25–34 years, those living in households with fewer than five members, and employed individuals were significantly less likely to own private health insurance. Rich economic status was the strongest predictor of private health insurance ownership (adjusted PR = 3.353; 95% CI: 1.997–5.627).
Conclusion: Private health insurance ownership in Indonesia is strongly shaped by socioeconomic characteristics and information exposure. These findings provide empirical evidence to support further investigation into the role of private health insurance as a complementary mechanism within Indonesia’s social health insurance-dominated system.
Keywords: Indonesia, ownership, private health insurance, socioeconomic factor
CAN EDUCATION INCREASE NHI MEMBERSHIP? A CASE STUDY AMONG MADURESE IN INDONESIA
Full text linkBackground: Madura Island is often left behind in health development in East Java Province, including in the health sector. Poverty and poor education dominate this region.
Aims: The research examined the role of education in National Health Insurance (NHI) membership among Indonesian Madurese.
Methods: The study employed 791 respondents. We used NHI membership as an outcome variable, education level as an exposure variable, and seven control variables: regency, residence, gender, employment, age, wealth, and marital status. In the last stage, we employed a binary logistic test.
Results: The results showed that 58.2% of Madurese people in Indonesia are members of the NHI. Regarding education level, Madurese with primary education was 1.672 times more likely than those without formal education to be an NHI member (95% CI 1.662-1.683). Meanwhile, Madurese with secondary education was 2.329 times higher than those uneducated to be an NHI member (95% CI 2.306-2.352). Moreover, Madurese with higher education was 4.593 times more likely to be an NHI member than uneducated Madurese (95% CI 4.517-4.669).
Conclusions: Education level was associated with NHI membership among Madurese in Indonesia. The higher the education level, the higher the possibility of being an NHI member.
Keywords: health insurance, National Health Insurance, Madurese, big data, public healt