International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

National Health Insurance Effects on Inpatient Utilization in Indonesia

Ahmad Nizar Shihab1, Armyn Nurdin2, Abdul Kadir3, HasbullahThabrany4, Idrus Paturusi3
1
Postgraduate Student, 2Faculty, 3Professor,
Faculty of Medicine, Universities Hasanudin, Indonesia
4
Professor, Faculty of Public Health, Universities Indonesia, Indonesia
Corresponding Author: Ahmad Nizar Shihab

ABSTRACT

Introduction: Disparities in geographic access, health facilities, human resources, health, and
economic status of the community resulted in disparities in the utilization of inpatient health care. It is
a challenge in achieving Universal Health Coverage (UHC) in Indonesia. The National Health
Insurance Program (JKN) was an attempt by the Indonesian government to achieve UHC. Since it was
first implemented in 2014, the membership of JKN includes 155.4 million people in 2015, rising to
171 million by 2016 from the total target of 254 million people in Indonesia to be achieved by 2019.
Aims & Objectives: This study aimed to analyze the effect of JKN on the utilization of inpatient care
in government hospitals and private hospitals of the year before (2013) and one year after (2015) the
National Health Insurance program (JKN) implemented.
Materials & Methods: This study uses a quantitative approach. Quantitative methods implemented
through literature and statistical data analysis of Susenas (National Social Economic Survey) in 2013
and 2015.
Results: The study found that the program JKN increase the utilization of hospitalization both in the
government and private hospitals. Number of percentages, delta values, and odds ratios illustrate that
JKN program open wider access to the nationwide inpatient utilization. The increase in inpatient
utilization can be influenced by several factors such as the increase in the number of health facilities
collaborate with National Health Insurance Agency (BPJS), and the increasing number of JKN
participants that got tuition assistance from the government for the poor and underprivileged
citizens/Recipient Contribution (PBI). Although all the provinces in Indonesia increased in utilization,
there are 17 provinces that are below the national average because of disparities in the availability of
facilities and infrastructure, health human resources, and equity in participation of JKN.
Conclusion: JKN Program increases the utilization of inpatient care in government and private
hospitals despite various disparities between provinces and regions of the major islands in Indonesia
are still found.

Keywords: Inpatient Utilization, National Health Insurance (JKN), Disparity, Universal Health
Coverage (UHC).

INTRODUCTION the middle class and reduced in the poverty

Along with efforts to achieve rate still leaves a gap for economic growth
Universal Health Coverage (UHC), that only benefited the richest which were
Indonesia faces challenges in guaranteeing 20% of the citizens. [1] Inequality is due to
equality of health services for the entire the undistributed of opportunities, jobs
community. Economic development in uneven, the high concentration of wealth
recent decades is believed to reduce poverty and high society that are exacerbated by
and improve the middle class. But the rise in corruption and low economic resilience.

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 Ahmad Nizar Shihab et al. National Health Insurance Effects on Inpatient Utilization in Indonesia

This condition leads to disparities in the provinces of 34 provinces in Indonesia still

field of health and the ability to access to could not have Community Health Center
health services. In response to this, the (Puskesmas)/ sub health center. Those
government in formulating policies and districts located in Aceh, South Sumatra,
social security assistance is expected to Banten, East Nusa Tenggara, North
overcome the existing imbalances. Kalimantan, North Sulawesi, Maluku, West
In the field of health, social security Papua and Papua. [2]
is manifested in the form of JKN program. Availability of health human
This is in accordance with the mandate of resources that guarantee the equitable health
Law No. 20 of 2004 on National Social services in Indonesia also remains a
Security System and Law No. 24 of 2011 on challenge. From 2.406 hospitals registered
Social Security Agency that all citizens are in 2014, there were 23.012 general
required to become participants of the practitioners or equal to ten general
national social security system in Indonesia. physicians per hospital. The number of
Since it first began on January 1, from 2014 general practitioners is still below the
through 2016, JKN program already national target of 40 doctors per 100.000
includes as many as 171 million participants populations. In 2014, the number of doctor
from the total target population of 254 ratios reached 16.18 per 100,000
million people of Indonesia. This covers populations. [3] Decentralization is expected
approximately 67% of the target to be to address the disparity in the health sector,
achieved in 2019. UHC policy in the field of although it still faces challenges due to
health, especially in the provision of social differences in fiscal capacity, less inequality
security became an important instrument to awareness and commitment of the head
reduce social inequalities. Gaps occur region, as well as a lack of understanding of
because of the inequality of opportunity that local government in providing public
led to the child of the poor could not get a services, including health. Various efforts in
chance in accessing good health services the provision of equitable health care for the
and facilities, also a skilled health care entire population become a goal that is
professionals. [1] Poor people also face based on the principle of equity. Therefore,
obstacles to obtaining a proper education to variety of health problems such as the level
overcome social inequality. of morbidity arising from conditions related
Equitable health care concerns to socioeconomic backgrounds can be
primarily on reducing the geographical tackled effectively. Thus, social injustice in
disparity, health facilities, human resources, health care as the goal of achieving UHC
health, and economic ability, especially for can be avoided. Based on this background,
the majority of poor people live in rural this study aimed to analyze the effects of
areas. In September 2015, the poor who live JKN against the utilizations of nationwide
in rural areas amounted to 62.76% of all the level for inpatient care either in government
poor people. Distribution of the population or private hospitals as an effort to see the
of poor is becoming a critical part in the progress in achieving the UHC 2019. [4]
provision of health care because although
JKN increased amount of participation, MATERIALS AND METHODS
equitable distribution of health facilities in This research was conducted with a
rural areas is still difficult to be fulfilled. quantitative approach through the analysis
This condition can be an obstacle for poor of statistical data from National Social and
people living in rural areas to gain access to Economic Survey (Susenas) in 2013 (before
health services. Similarly, the availability of JKN implemented) and 2015 (after JKN
health facilities is still a constraint. Village implemented). [5] Analysis related inpatient
Potential Survey 2014 noted about 117 utilization patterns in this study involving
(1.65%) districts of the 7.074 districts in 9 hospitalization in government and private

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 Ahmad Nizar Shihab et al. National Health Insurance Effects on Inpatient Utilization in Indonesia

hospitals. Analysis of utilization used the September, and December. Meanwhile

percentage of utilization per province, while Susenas implementation in 2015 was
a comparative analysis between regions in conducted in March and September include
Indonesia conducted by divided object 300.000 households by the number of
region into seven groups of large islands samples spread over 34 provinces and 511
consist of Java, Bali, Sumatra, Nusa districts/cities in Indonesia. The instrument
Tenggara, Kalimantan, Sulawesi, Maluku used questionnaire consisted of two (2)
and Papua. Data analysis conducted by types of questionnaires, Kor questionnaires
univariate and multivariate analysis of the and questionnaires for Consumption and
data Susenas. Expenditure.
Susenasis a survey to gather
information/ data in the areas of population, RESULT
health, education, family planning, housing, The study found that increasing
as well as consumption and expenditure percentage of program JKN in inpatient
conducted by the Central Statistics Agency utilization at nationwide level from 2.30%
(BPS). The unit of analysis used in Susenas in 2013 to 3.42% by 2015 with a significant
is the household. Susenas 2013 increase (p = 0.0001). The increase in this
implemented in 2012 with the questionnaire percentage occurred in inpatient utilization
and the number of samples Kor each quarter both in the Government and Private
by 75.000 households. [5] Data retrieval Hospital in all provinces and islands areas in
survey was conducted in March, June, Indonesia (Figure 1 and Figure 2).

Figure 1. Trends in Utilization of Inpatient per Province in Indonesia (2013-2015)

Source: Data from Susenas 2013 and 2015

Graph inpatient utilization trends per there are 17 provinces with the percentage
province were processed from the data of inpatient utilization below the average
Susenas 2013 and 2015. Susenas data shows national value, they are the provinces of
the percentage increase in utilization from West Java, Bengkulu, South Kalimantan,
2013 until 2015. The province of Banten, Riau, Jambi, Lampung, West
Yogyakarta has a highest percentage of Papua, West Sulawesi, South Sumatra, West
utilization of hospitalization in 2015 and Kalimantan, Borneo Central, North
Maluku as a province with the lowest Sumatra, Southeast Sulawesi, North
percentage. From the total 34 provinces, Maluku, Papua, and Maluku.

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Figure 2. Percentage of Inpatient utilization in Government and Private Hospitals based on Islands Region in Indonesia year 2013
and 2015
(Susenas, 2013 and 2015)

The archipelago based review Table 2. Odds Ratio Inpatient utilization in RS Government
and Private Hospitals per Islands Region (2013 and 2015)
showed the highest percentage of utilization Government Hospitals Private Hospitals
for inpatient care in public hospitals are in Variabel Odds Ratio Variabel Odds Ratio
Sumatera 1.079 Sumatera 4.113
the Sulawesi island areas with a value of Jawa Bali 1.160 Jawa Bali 4.956
2.26%, while the region with the lowest Nusa Tenggara 1.520 Nusa Tenggara 2.968
Kalimantan 1.265 Kalimantan 2.049
percentage of utilization are in the Maluku Sulawesi 1.724 Sulawesi 2.595
islands with a value of 1.31%. As for private Maluku 1.003 Maluku 1.254
hospitals, the highest percentage value is in Papua (referensi) Papua (referensi)
_cons 0.003 _cons 0.001
Java Bali with a value of 1.51% and the Source: Data from Susenas (2013 and 2015)
lowest in Papua with the percentage of
0.31%. Value figures illustrate the rate of
utilization (increase in utilization rate)
Table 1. Values Delta (Increase in Utilization Rate) per Islands
Region in Indonesia year 2015-2013
hospitalization in government and private
Government Hospitals Private Hospitals hospitals in 2015 compare with 2013 in the
Papua 0.99 Papua 0.72 islands area in Indonesia. Papua is a region
Kalimantan 0.88 Kalimantan 0.67 with highest increase in utilization rate for
Sumatera 0.66 Sumatera 0.63
Maluku 0.64 Maluku 0.59 hospitalization in both the government
Sulawesi 0.60 Sulawesi 0.55 (delta 0.99) and private hospitals (delta
Nusa Tenggara 0.49 Jawa Bali 0.54
Jawa Bali 0.47 Nusa Tenggara 0.24 0.72). However, the lowest utilization in the
Source: Data from Susenas (2013 and 2015) government hospital (delta 0.47) contained

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in the Java-Bali region and the lowest value of utilization for hospitalization by
utilization numbers at private hospitals 1%. In addition to the utilization, the
occurred in the area of Nusa Tenggara (delta number of cases handled in hospital also
0.24). Delta value is obtained from the increased from 31 million in 2014 to 46
difference in numbers inpatient utilization in million in 2015. While the number of users
2015 compared to 2013. of Advanced Level Referral Health
In addition, to determine the value of Facilities (FKRTL) rose from 9.1 million to
the probability of utilization, this study 13.5 million from 2013 to 2015. [8-9]
analyzes the odds ratio per region of Inpatient utilization continues to
inpatient utilization care in government and increase along with the increase in the
private hospitals, with reference to the number of participants and the increase in
island of Papua. Based on the value of the the number of health care facilities that
odds ratio per region, the results of this become partners in the JKN program. Until
study showed that Sulawesi become the October 2016, JKN participation of various
region with the highest probability of segments increased. The increase in the
hospitalization in utilization at the number of participants is supported by
government hospital in the amount of 1.724 contributions from government aid for the
compared with an odds ratio of Papua populations of poor and destitute who were
region. While in private hospital the odds included in a segment of participants
ratio value inpatient utilization was highest Recipient Contribution (PBI). It becomes
in the region of Java Bali (4.956) compare leverage the increase in participants JKN as
to Papua region. showed by the number of participants from
PBI segment that dominate the amount of
DISCUSSION participation with about 62.29% or
The increase in percentage, delta 105.627.593 number of people. This amount
values, and odds ratio shows that the JKN comes from the transformation of the
program has opened access of inpatient participants Citizen Health Insurance
utilization in both the government and (Jamkesmas), Regional Health Insurance
private hospitals nationwide. This condition (Jamkesda), and additional data from the
is one of the effects of the implementation eligible citizens for assistance. The second
of the mandate of the Social Security Act segments were Participant of Workers Wage
and the Act of BPJS which states that all Recipients (PPU) with about 23.74% or
citizens shall be a participant of JKN 40.260.548 people. While the participants of
program. The increase in this percentage the segment Non Wage Receiver Workers
also illustrates that health insurance is able (PBPU) has a percentage of 10.99%
to reduce the burden of the public in compare to the total participants JKN or as
accessing health services. This is consistent many as 18.642.251 people. The lowest
with studies conducted in 48 countries in segment of participants came from Non
2002-2004 involving 197.914 respondents Employees (BP) participants with a number
resulted that the health insurance increases about 5.043.618 people or only 2.97%.
the chances of people to access health In addition to the membership, the
services for NCD (non-communicable number of health facilities is also a factor
diseases), especially for people who are contributing to increased utilization. BPJS
disadvantaged in terms of social and data shows that the number of Primary
economy, rural communities, and women. [6] Health Facilities (FKTP) rise from 12.993 in
In 2014, the utilization rate/JKN 2013 to 19.969 in 2015, and until April
utilization for inpatient services amounted 2016 have reached to 20.095 facilities.
to 3.99%. [7] This figure is much larger Moreover, the Advanced Level Referral
when compared with the utilization of Health Facilities (FKRTL) has grown from
health services in 2009 which showed the 1.877 hospitals, 1.910 pharmacies and 927

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opticals. FKRTL amount is not limited to the needs of health infrastructure. [12] For
government-owned facilities but also many developing countries such as
includes 901 private hospitals who have Indonesia, limited health facilities were
worked together with BPJS. Number of caused due to constraints in limited access
private hospitals already covers 48% of the to health services. [13] In addition to limited
total FKRTL which have become partners in access, the availability of health services
the JKN program. Despite an increase in the and resources is also very decisive. [14] This
percentage of people throughout the is in line with the results of the evaluation
province in Indonesia, there is still a wide from Ministry of National Development
gap in utilization of hospitalization in 17 Planning (Bappenas) showed that the value
provinces out of 34 provinces in Indonesia. of utilization is affected by factors relating
The results of this study indicate DI to the availability of facilities and
Yogyakarta province has the highest infrastructure for the JKN participants. [7]
percentage of hospitalization and Maluku as For example, the number of hospitals in
a province with the lowest percentage of Indonesia has increased from year to year,
hospitalization in 2015. Meanwhile, but the equal distribution of these facilities
increased in utilization is highest in Aceh remains a challenge. A survey conducted by
province and the South Sulawesi and the Ministry of Health in 2015 showed that
Maluku province is an area with lowest in terms of the availability of beds, there are
increased in utilization. 13 of the 33 provinces in Indonesia with the
Regional disparities in utilization ratio of beds per 1000 population below 1
indicate that JKN had a varied impact on i.e. in West Nusa Tenggara, Lampung, West
decentralization. This is consistent with Java, West Sulawesi, Kalimantan Central,
research at the world level which indicates Central Sulawesi, Banten, East Nusa
that there is a relationship between Tenggara, Riau, Jambi, South Sumatra, East
decentralization and health care disparities. Java and Papua. In addition to meeting the
Countries such as Chile and Columbia are needs of the number of available beds,
examples of countries that can expand improving health services also need to
access to health services with a consider the quality of existing services with
decentralized system. [10] Similar results the revitalization of the health system in the
were also found in Canada that showed utilization of bed. [15] Equity of quality
decentralized improve public access to health facilities is also necessary to ensure
services of general practitioners, specialists access to health services, as well as the
and hospital services. [11] However, results of research in West Sumatra finds
decentralization in Switzerland does not that the equalization ratio of health workers
ensure equity of access is the better because and health facilities should be taken
of differences in cantonal policies. seriously as an effort in achieving UHC in
Therefore, decentralization needs to be the province of West Sumatra. [16] In this
balanced with policies and subsidies from case, the responsibility on fulfilling health
the central supports. [12] In Indonesia facilities needs were given to local
support from central government is given in government as stipulated in Law No. 23
the form of subsidies tuition for PBI Year 2014 on Regional Government and
participants. Law No. 44 of 2009 about Hospitals. These
Several factors such as differences in responsibilities imposed on local
the availability of health infrastructure, government because local government
health human resources, financial capability, knows better the level of the needs.
and regional health insurance have led to the Differences in utilization per
disparity between regions in Indonesia. In province are related to inter-provincial
terms of facilities and infrastructure, disparity conditions, for example in the
Indonesia still faces challenges in meeting geographical access to health facilities.

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Studies conducted by the National Team to owned by Central Government or Local

Accelerate Poverty (TNP2K) in 2011 Government. In adition, in the early stages
showed that the rate of utilization of health of the implementation of the program, a
services in the former Jamkesmas was low priority for graduate education primarily
due to geographical access to health focused on the profession of obstetric and
facilities not supported by adequate gynecology, pediatricians, surgeons,
transportation facilities. [17] In terms of internists, anesthesia and intensive therapy
distance to health facilities also showed that specialist.
although the average distance to a health
facility in Indonesia is only 5 km, but in b. Expansion of JKN Membership
provinces such as West Papua, Papua and Constraints
Maluku average time distance is still quite Challenges in the expansion of the
distant. coverage also affect the utilization of
inpatient care in a number of provinces in
a. Availability of Health Professional Indonesia. There are 10 provinces with the
Constraints largest population that has not yet covered it
Availability of health workers is whole population into JKN program, those
supporting health services so that the provinces are West Java, East Java, Central
shortage of health professionals in Indonesia Java, North Sumaera, Banten, South
is very crucial. As research on the Linga Sumatra, South Sulawesi, Riau, Lampung
(Riau Islands) found that in order to and West Kalimantan. The total population
improve the effectiveness of health services, of non JKN member in those 10 provinces
especially the referral system, availability of reached the number about 90 million
general practitioners and specialists is people. [7] The main cause of this
crucial. [18] Other research in Natuna Islands participation problem due to unregistered
found that the role of local government is citizen that mainly from informal workers,
very important in equity and distribution of integration of Jamkesda that is not yet
health personnel. [19] Application of this finished, as well as accuration of population
political commitment has been evident in and employment data synchronization
some countries such as China, Costa Rica, constraints facing the government today. [17]
Cuba, Kerala, and Sri Lanka. [20] In Results of research for informal sector
overcoming disparities of health workers (truck drivers) in Semarang found
professionals, the Indonesian government that despite having the Ability to Pay but
take the initiative in the form of special willingness to Pay in JKN program is
incentives to specialists started in early 2017 relatively low. In addition to the foregoing,
and the program Compulsory Labour for the socialization program in the target
Specialist Physician stipulated in communities, especially grassroots groups is
Presidential Decree (Surpres) No. 4 Year not optimal, service procedures are still
2017 concerning Compulsory Work of complicated to coordinate that has not been
Medical Specialist. This work is done in well established between the organizer and
order to empower specialists in an effort to the relevant agencies such as the
equitable health care and meeting the needs Department, Local Government, and health
of health services to the community. facilities that provide services. [21]
According to this regulation, the participants The increase in utilization, in
of Compulsory Work of Specialist Doctors addition to impact on the opening of access
placed on: a. Hospitals at remote area, also deals with financing the JKN program.
border and small island; b. Referral hospital Data by groups of participants between
in regions; or c. Referral hospital in the PBPU and Non PBPU, it is known that there
province, in the entire territory of Indonesia. are differences in the financial burden of
Referred hospital includes the facilities health insurance that is disproportionate to

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the number of participants and the existing Data from BPJS in Pardede (2016)
license fee revenue. The number of showed that the actual proportion of health
participants in the group PBPU when care costs in 2015 BPJS dominated by
compared with non-PBPU group was 10% services for catastrophic illness.
versus 90% or 14.96 million compared to Catastrophic costs reached 23.90% of the
141.83 million participants. Revenue actual cost of health care. As many as 1.3
contribution from PBPU group contributed million people or 0.8% of participants JKN
only 11% of total revenue (5.9 trillion) got catastrophic care with the most cost
compare to the non PBPU that contributed spent on heart disease and diseases Chronic
as much as 89% (48.1 trillion rupiah). Renal Failure (Hemodialysis). From 2015,
However, the burden of health care catastrophic care costs for hospitalization in
financing illustrates PBPU groups absorb heart disease is the biggest expenditure
the cost of 29% of total expenditure or of which is then followed by the service charge
16.678 trillion rupiah compared to the non expenditure of cancer, stroke, renal failure,
PBPU with the absorption of costs by 71% Thalassemia, Cirrhosis, Hepatitis, leukemia
or equal to 40.405 trillion rupiah. This and hemophilia. The high cost of
imbalance occurred because the group catastrophic care covered by BPJS becomes
PBPU generally dominated by those who a financial burden of BPJS. The high cost of
have a high risk of sickness, especially catastrophic care needs to be balanced with
chronic pain and catastrophic sickness. [9] promotion and preventive measures, thereby
This is where the function of mutual reducing the cost burden of financial claims
cooperation is realized, healthy participants against the state. The findings in health
(Non PBPU) helps the sick (PBPU). insurance in the Philippines indicated that
In terms of utilization, JKN program efforts to control the cost of health
were used by both PBI participants and non insurance claim are needed to avoid a high
PBI. However, the utilization of non PBI burden for state finances. [22] However, it is
participants is higher compared to patients recognized that the condition of the high
PBI. Increases in CBGs (Case Based cost of catastrophic claims in Indonesia as a
Groups) Non PBI participants reached positive side of social security system that
58.16% from 2014 (22.817.363) to 2015 does not recognize the adverse selection
(36.088.022), while the increase in claims guarantees like those in private insurance.
CBGs PBI participants reached only 23.91% This means that these guarantees able to
from 8.18 million cases in 2014 to 10.76 protect all people in all health conditions.
[23]
million cases in 2015 (BPJS in Pardede, Health insurance, especially for people
2016). Participants of non PBI also who face catastrophic illnesses is needed
dominates claims for services in FKRTL and generally require high financing. This is
with a 56.88% rise from 2014 (6.208.519) to in line with the results of research in South
2015 (9.740.034). The increase in service Korea that found the disease burden on
users from PBI group only reached 28.59% society because of catastrophic health costs
of the 2.9 million people in 2014 to 3.78 is very high. Thus, a family with this
million in 2015. This brings the total claims catastrophic disease burden must reduce all
cost of treatment of participants Non PBI the needs for other living expenses. [24]
cost is much higher compared with PBI While the case in China showed spending
participants. It can be traced further in the on physical health reduces productivity in
use and distribution of the card. PBI the production of resources and reduces the
participants who have not received a card, costs of other basic needs of life. [25]
and participants who did not understand the Without the assurance to the public to
use of the card will be one of the causes PBI finance catastrophic illness, the risk of
participants utilization is low. health costs will be very high and not
affordable. Evidence in Vietnam showed

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that social security be a buffer against participants who use health services, as well as
income loss due to health care costs due to the types of claims filed. Inadequate number of
catastrophic illness. [26] However, a study participants of the group PBPU shows that to
conducted in South Korea showed that the achieve UHC still open to embrace the potential
of this group by increasing the dissemination
policy of health insurance for catastrophic
and promotion of preventive efforts on the risk
illness costs is even more positive impact on of severe illness. In addition, the trend of the
the rich than the poor. This is because the current participants showed that patients PBI
proportion of the costs incurred for the lower utilization compared with patients with
treatment of catastrophic equally between non PBI. This shows that the public accessibility
the rich and the poor will be more damaging of participants PBI is lower and thus requires
to the poor due to their inability to pay. So more attention, especially for patients PBI is a
the health insurance policy should seek to participant of the poor who live in rural areas.
really protect the poor from the burden of Whereas, in the case of a service charge claims
the cost of this kind, which in turn can known of the financing trends catastrophic
trigger further poverty.[27] For that guarantee illness costs were very high compared to the
cost of other services, it is necessary for
a thorough urgently needed because of the
preventive promotive steps in overcoming the
poor spending out of pocket although little adverse claim this catastrophic costs. In
can be a heavy burden. addition, up to the challenge disparities are also
required to strengthen health services in primary
CONCLUSION health care facilities. Provision of facilities and
The study found that an increase in infrastructure, human resources, and equity
the percentage of utilization of inpatient participation in primary health care facilities in
nationally significant before the JKN era are absolutely necessary. To carry out
implementation of JKN in 2013 and one this effort, BPJS as executor of JKN needs the
year after the implementation of JKN in support from the central government and local
2015. In addition, the delta value describes governments to UHC objectives can be achieved
the utilization rate is highest in Papua region in accordance with the expected target in the
coming 2019.
in both the government and private hospital.
While the value of the odds ratio represents Authors’ Contribution
the probability of utilization in government The first authors had made substantial
hospitals is highest in the region of contributions to conception, design, collection
Sulawesi, and for the private hospitals are of data, analysis and interpretation of the data;
highest in the islands of Java and Bali. The drafting the article, revising it critically for
increase in percentage, utilization rate, and important intellectual content; and final
the odds ratio indicates that JKN program approval of the version to be published. The
open access of inpatient utilization in both second, third, fourth and fifth author had given
the government and private hospitals substantial advice to the first author in
nationwide. Despite the national trend of developing concept, methodology, collection of
data, and discussion of the content.
increasing utilization, there is still a
disparity in health services between islands ACKNOWLEDGEMENT
and between provinces in Indonesia. This journal is part of a study to qualify
Disparities in health care are related to the the graduate level of the author at the Graduate
availability of facilities and infrastructure, Program Hasanuddin University, Indonesia.
health human resources, and equity of
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How to cite this article: Shihab AN, Nurdin A, Kadir A et al. National health insurance effects on
inpatient utilization in Indonesia. Int J Health Sci Res. 2017; 7(4):96-106.

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