1,720,958 research outputs found
AN ANALYSIS BASED ON CARE NEEDS OF CARDIOVASCULAR DISEASES
No full textBackground: Noncommunicable diseases (NCDs) are the leading cause of death worldwide, with cardiovascular diseases (CVDs) being the largest contributor. Seventy-three percent of NCD deaths occur in low- and middle-income countries (LMICs), where the population aged ≥60 years is projected to nearly double by mid-century. In Indonesia, rapid demographic and epidemiological transitions have intensified healthcare and long-term care (LTC) demands, yet evidence linking these changes to system responses remains limited.
Objective: This thesis examines healthcare utilization and LTC among older adults in Indonesia, focusing on individuals with CVDs. It aims to assess healthcare costs, evaluate the impact of the COVID-19 pandemic on service utilization, project future LTC expenditure, and explore policymaker perspectives on Indonesia’s transition from informal to formal LTC systems.
Methods: A mixed-methods design was employed, integrating quantitative and qualitative components. Study I used National Health Insurance (NHI) claims data from 2016–2018 (N = 271,065) and applied a three-level linear mixed-effects model (individual, household, and district levels) to examine associations between CVDs, with or without other chronic disease comorbidities, and healthcare costs. Study II analyzed longitudinal NHI data from 2016–2020 (N = 378,495) using interrupted time-series analysis to evaluate the impact of COVID-19 on healthcare utilization. Study III employed a macro-simulation model to project LTC costs for adults aged ≥60 years (N ≈ 35 million in 2025). Study IV conducted in-depth interviews with nine policymakers and analyzed them using inductive qualitative content analysis.
Results: Adults with CVDs and multimorbidity incurred nearly twice the healthcare costs of those with CVD alone. Among higher-income groups, mean outpatient costs were USD 119.5 (SD 264.1) for CVDs and multimorbidity versus USD 49.1 (SD 153.6) for CVD alone; among lower-income groups, USD 79.9 (SD 202.4) versus USD 36.7 (SD 127.5). Healthcare utilization declined markedly during the COVID-19 pandemic: hospital outpatient visits decreased 32% (95% CI 0.55–0.85), inpatient visits 18% (95% CI 0.71–0.95), and primary-care visits 23% (95% CI 0.63–0.94). LTC expenditure is projected to increase from USD 3.2 billion in 2025 to USD 19.2 billion in 2045—equivalent to a rise from 0.94% to 2.06% of GDP—driven primarily by home-based care. Stakeholders emphasized the need to balance family, community, and state responsibilities in developing equitable and sustainable LTC systems.
Conclusion: Cardiovascular disease and multimorbidity were associated with substantially higher healthcare costs and resource utilization among Indonesian adults, with subsidized households showing lower healthcare use and spending reflecting socioeconomic barriers to access. Beyond healthcare utilization, LTC needs and costs are projected to rise sharply, highlighting a central policy challenge: defining the respective roles of the state, families, and communities in future care provision. As Indonesia remains a relatively young nation, investments in population health and NCD prevention will be critical, as these will strongly influence both healthcare utilization and future LTC demand. Preventive strategies and prioritizing the development of public facilities that promote healthy aging and inclusivity are essential to building a resilient, equitable, and sustainable LTC system aligned with Indonesia’s broader development and social protection goals
The sensitivity of hospital coding to prices:evidence from Indonesia
Get PDFThis study examines a newly introduced DRG system in Indonesia. We use secondary data for 2015 and 2017 from Jaminan Kesehatan Nasional (JKN), a patient level dataset for Indonesia created in 2014 to record public and private hospitals' claims to the national health insurance system to investigate whether there is an association between changes in tariffs paid and the severity of inpatient activity recorded in hospitals. We find a consistent small, positive and statistically significant correlation between changes in tariffs and changes in concentration of activity, indicating discretionary but limited coding behaviour by hospitals. The results indicate that reducing price differentials may mitigate discretionary coding, but that the benefits of this are limited and need to be compared to the potential risk of having to rebase all prices upwards
The impact of multimorbidity among adults with cardiovascular diseases on healthcare costs in Indonesia : a multilevel analysis
No full textBackground: Cardiovascular diseases (CVDs) are the leading cause of death in Indonesia, accounting for 38% of the total mortality in 2019. Moreover, healthcare spending on CVDs has been at the top of the spending under the National Health Insurance (NHI) implementation. This study analyzed the association between the presence of CVDs with or without other chronic disease comorbidities and healthcare costs among adults (> 30 years old) and if the association differed between NHI members in the subsidized group (poorer) and non-subsidized households group (better-off) in Indonesia. Methods: This retrospective cohort study analyzed the NHI database from 2016–2018 for individuals with chronic diseases (n = 271,065) ascertained based on ICD-10 codes. The outcome was measured as healthcare costs in USD value for 2018. We employed a three-level multilevel linear regression, with individuals at the first level, households at the second level, and districts at the third level. The outcome of healthcare costs was transformed with an inverse hyperbolic sine to account for observations with zero costs and skewed data. We conducted a cross-level interaction analysis to analyze if the association between individuals with different diagnosis groups and healthcare costs differed between those who lived in subsidized and non-subsidized households. Results: The mean healthcare out- and inpatient costs were higher among patients diagnosed with CVDs and multimorbidity than patients with other diagnosis groups. The predicted mean outpatient costs for patients with CVDs and multimorbidity were more than double compared to those with CVDs but no comorbidity (USD 119.5 vs USD 49.1, respectively for non-subsidized households and USD 79.9 vs USD 36.7, respectively for subsidized households). The NHI household subsidy status modified relationship between group of diagnosis and healthcare costs which indicated a weaker effect in the subsidized household group (β = -0.24, 95% CI -0.29, -0.19 for outpatient costs in patients with CVDs and multimorbidity). At the household level, higher out- and inpatient costs were associated with the number of household members with multimorbidity. At the district level, higher healthcare costs was associated with the availability of primary healthcare centres. Conclusions: CVDs and multimorbidity are associated with higher healthcare costs, and the association is stronger in non-subsidized NHI households. Households’ subsidy status can be construed as indirect socioeconomic inequality that hampers access to healthcare facilities. Efforts to combat cardiovascular diseases (CVDs) and multimorbidity should consider their distinct impacts on subsidized households. The effort includes affirmative action on non-communicable disease (NCD) management programs that target subsidized households from the early stage of the disease
Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia : an interrupted time-series analysis
No full textBackground: The COVID-19 pandemic has disrupted healthcare utilization globally, but little is known about the effects among patients with cardiovascular diseases (CVDs) and other multimorbidities. This study analyzed the impacts of COVID-19 on healthcare utilization for patients aged 30 years and older with cardiovascular diseases (CVDs) with or without other chronic disease comorbidities in Indonesia. Methods: We designed a retrospective cohort study based on the Indonesian National Health Insurance (NHI) sample data from 2016–2020. We defined healthcare utilization as monthly outpatient and inpatient visits related to chronic diseases at the hospital and primary healthcare levels per 10,000 NHI members. We used interrupted time series analysis to evaluate how the healthcare utilization patterns had changed due to the COVID-19 pandemic. Results: Overall, hospital outpatient visits decreased by 39% when the pandemic occurred (95% Confidence Interval (CI): 0.48,0.76), inpatient visits by 28% (95% CI: 0.62,0.83), and primary healthcare visits by 34% (95% CI:0.55, 0.81). For patients with CVDs and multimorbidity, hospital outpatient and inpatient visit rates were reduced by 36% and 38%, respectively and primary healthcare visits by 32%. Some insignificant differences in the reduction of out-and inpatient visits were observed across diagnosis groups and regions. Conclusion: Healthcare utilization among patients with chronic diseases decreased significantly during COVID-19 and consistently across different chronic diseases and regions. To cope with the unmet needs of healthcare utilization in the context of the pandemic, the healthcare system needs to be strengthened to cater to the needs of the population-at-risk, especially for patients with CVDs and multimorbidity.
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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