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研究生:HAFIDZA AULIYA
研究生(外文):HAFIDZA AULIYA
論文名稱:Association between Increased Universal Health Coverage and Disparities in Healthcare Access Among Reproductive-Age Women in Indonesia: evidence from Demographic Health Surveys 2012 and 2017
論文名稱(外文):Association between Increased Universal Health Coverage and Disparities in Healthcare Access Among Reproductive-Age Women in Indonesia: evidence from Demographic Health Surveys 2012 and 2017
指導教授:高志文高志文引用關係
指導教授(外文):WAYNE GAO
口試委員:高志文黃麗玲MATTIA SANNA
口試委員(外文):WAYNE GAOLI LING HUANGMATTIA SANNA
口試日期:2024-05-30
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:全球衛生暨衛生安全碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2024
畢業學年度:112
語文別:英文
論文頁數:59
中文關鍵詞:Health insuranceBarriers in access healthcareIndonesia Demographic Health and Survey.
外文關鍵詞:Health insuranceBarriers in access healthcareIndonesia Demographic Health and Survey.
IG URL:https://www.instagram.com/unyilily/?hl=en
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Background: Access to healthcare is vital for individual well-being, especially for vulnerable groups like women of reproductive age. Understanding healthcare access dy- namics and identifying barriers are critical for improving healthcare delivery and promot- ing health equity. Indonesia has made strides toward universal health coverage (UHC) through the Jaminan Kesehatan Nasional (JKN) program, yet challenges persist in en- suring equitable access. Objective: To analyze what trends of the problems in accessing healthcare in 2012 and 2017. Second, to examine the association between barriers to accessing healthcare and health insurance status among women of reproductive age in Indonesia in 2012 and 2017. Methodology: Using data from the Indonesia Demographic Health Survey (IDHS), the study involved 45,607 participants from 2012 and 49,627 from 2017, employing de- scriptive analyses, Pearson chi-square tests, and multiple logistic regression analysis. Results: In 2012, 37.1% of reproductive-aged women had health insurance, which was associated with a lower likelihood of financial difficulties (AOR=0.83, 95% CI:0.75, 0.92) and challenges in accessing healthcare alone (AOR=0.92, 95% CI: 0.85, 1.00). By 2017, the coverage increased to 58.2%, showing similar protective effects against challenges in accessing healthcare alone (AOR=0.93, 95% CI: 0.88, 0.99) and financial difficulties (AOR=0.85, 95% CI: 0.79, 0.92). Conclusion: A significant association between health insurance and access chal- lenges among reproductive-aged women, with consistent results from 2012 to 2017. This underscores the potential of health insurance in facilitating healthcare access and address- ing financial barriers.
Background: Access to healthcare is vital for individual well-being, especially for vulnerable groups like women of reproductive age. Understanding healthcare access dy- namics and identifying barriers are critical for improving healthcare delivery and promot- ing health equity. Indonesia has made strides toward universal health coverage (UHC) through the Jaminan Kesehatan Nasional (JKN) program, yet challenges persist in en- suring equitable access. Objective: To analyze what trends of the problems in accessing healthcare in 2012 and 2017. Second, to examine the association between barriers to accessing healthcare and health insurance status among women of reproductive age in Indonesia in 2012 and 2017. Methodology: Using data from the Indonesia Demographic Health Survey (IDHS), the study involved 45,607 participants from 2012 and 49,627 from 2017, employing de- scriptive analyses, Pearson chi-square tests, and multiple logistic regression analysis. Results: In 2012, 37.1% of reproductive-aged women had health insurance, which was associated with a lower likelihood of financial difficulties (AOR=0.83, 95% CI:0.75, 0.92) and challenges in accessing healthcare alone (AOR=0.92, 95% CI: 0.85, 1.00). By 2017, the coverage increased to 58.2%, showing similar protective effects against challenges in accessing healthcare alone (AOR=0.93, 95% CI: 0.88, 0.99) and financial difficulties (AOR=0.85, 95% CI: 0.79, 0.92). Conclusion: A significant association between health insurance and access chal- lenges among reproductive-aged women, with consistent results from 2012 to 2017. This underscores the potential of health insurance in facilitating healthcare access and address- ing financial barriers.
Contents
Abstract i
Acknowledgement ii
Contents iii
List of Figures v


List of Tables vi

1 Introduction 1
1.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2.1 Research Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2.2 hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 Literature Review 6
2.1 Universal Health Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.2 Health Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.1 Health Insurance Coverage Type in Indonesia . . . . . . . . . . . . . . 14
2.3 Women’s Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.4 Access to Health Care Facility . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.5 Association between Health Insurance and Barrier to Access Healthcare . . . 24
3 Study Design and Methods 26
3.1 Study Design, Setting, and Data Source . . . . . . . . . . . . . . . . . . . . . 26
3.2 Sampling Method and Study Participants . . . . . . . . . . . . . . . . . . . . 27
3.3 Measurement of Variables / Study Variables . . . . . . . . . . . . . . . . . . 28
3.3.1 Dependent Variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.3.2 Independent Variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.4 Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.5 Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
iii
4 Results 34
4.1 Assess The Characteristics of Participants . . . . . . . . . . . . . . . . . . . 34
4.2 Assess the change in health insurance coverage and barriers to accessing
healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.3 Association between barriers to accessing healthcare and national health . . 41
5 Discussion 47
5.1 Characteristic participants of study . . . . . . . . . . . . . . . . . . . . . . . 47
5.2 Assess the change in health insurance coverage and barriers to accessing
healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.3 Association between barriers to accessing healthcare and national health in-
surance status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
5.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
5.5 Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
REFERENCE 56

List of Figures
3.1 Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31


List of Tables
2.1 Percentage of women ages 15-49 with specific types of health insurance cov-
erage, according to background characteristics, Indonesia 2012. . . . . . . . 12
2.2 Percentage of women age 15-49 with specific types of health insurance cov-
erage, according to background characteristics, Indonesia 2017. . . . . . . . 13
2.3 Percentage of women age 15-49 who reported that they have serious prob-
lems in accessing health care for themselves when they are sick, by type of
problem, according to background characteristics, Indonesia 2012. . . . . . . 19
2.4 Percentage of women age 15-49 who reported that they have serious prob-
lems in accessing health care for themselves when they are sick, by type of
problem, according to background characteristics, Indonesia 2017. . . . . . 20
4.1 Characteristics of participants by survey year (weighted) . . . . . . . . . . 34
4.2 Characteristics of participants (p-value) . . . . . . . . . . . . . . . . . . . . 35
4.3 Participants’ characteristics by health insurance coverage across survey waves
(weighted) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
4.4 Participants characteristics by health insurance coverage across survey waves
(p-value) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.5 Association of perceived barriers in accessing health care and health insur-
ance coverage in Indonesia in 2012 . . . . . . . . . . . . . . . . . . . . . . . 41
4.6 Association of perceived barriers in accessing health care and health insur-
ance coverage in Indonesia in 2017 . . . . . . . . . . . . . . . . . . . . . . . 44

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