Differences in Hemodialysis Claim Patterns Across Membership Types Among Patients With Renal Failure Based on National Health Insurance Data From 2017 to 2022: Cross-Sectional Analysis.
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| Název: | Differences in Hemodialysis Claim Patterns Across Membership Types Among Patients With Renal Failure Based on National Health Insurance Data From 2017 to 2022: Cross-Sectional Analysis. |
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| Autoři: | Munandar A; Department of Social Welfare, Faculty of Social and Political Science, University of Bengkulu, Bengkulu, Indonesia., Hasibuan SR; Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia.; Center for Health Administration and Policy Studies, Faculty of Public Health, University of Indonesia, Depok, Indonesia., Kusuma D; Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates. |
| Zdroj: | JMIR public health and surveillance [JMIR Public Health Surveill] 2025 Nov 03; Vol. 11, pp. e73731. Date of Electronic Publication: 2025 Nov 03. |
| Způsob vydávání: | Journal Article |
| Jazyk: | English |
| Informace o časopise: | Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101669345 Publication Model: Electronic Cited Medium: Internet ISSN: 2369-2960 (Electronic) Linking ISSN: 23692960 NLM ISO Abbreviation: JMIR Public Health Surveill Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Toronto : JMIR Publications, [2015]- |
| Výrazy ze slovníku MeSH: | Renal Dialysis*/statistics & numerical data , Renal Insufficiency*/therapy , Renal Insufficiency*/epidemiology , National Health Programs*/statistics & numerical data , Healthcare Disparities*/statistics & numerical data, Humans ; Cross-Sectional Studies ; Male ; Female ; Middle Aged ; Adult ; Indonesia/epidemiology ; Aged ; Adolescent ; Health Services Accessibility/statistics & numerical data |
| Abstrakt: | Background: Chronic kidney disease and end-stage renal disease are major contributors to the disease burden in low- and middle-income countries, including Indonesia. Despite the expansion of universal health coverage through Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, Indonesia's national health insurance program, disparities in access to hemodialysis persist across different socioeconomic and geographic groups. Understanding these inequities is critical to advancing equitable health care access. Objective: This study aimed to examine disparities in hemodialysis claim patterns as a proxy for access among adult patients with renal failure enrolled in BPJS, focusing on differences by membership type, sex, age, geographic region, urbanicity, and facility ownership. Methods: We conducted a cross-sectional analysis of 38,383 anonymized health insurance claims between 2017 and 2022 for patients with renal failure who were aged ≥18 years. The primary outcome was receipt of hemodialysis. We used multivariate logistic regression to estimate adjusted odds ratios (aORs) for receiving hemodialysis across BPJS membership types and other covariates. Subgroup analyses were performed by sex, facility ownership, urbanicity, and geographic region. Robust SEs and probability weights were applied to account for the sample design. Results: Of the total renal failure claims, 75.6% (29,017/38,383) involved hemodialysis. Compared with individuals in the lowest income group (ie, members subsidized under the national government budget), informal workers (aOR 1.56, 95% CI: 1.34-1.82); P<.001) and members subsidized under the local government budget (aOR 1.31, 95% CI: 1.05-1.63); P=.017) had higher odds of receiving hemodialysis, while formal sector workers had lower odds (aOR 0.81, 95% CI: 0.68-0.98); P=.028). Disparities were more pronounced in rural areas and among women; for example, in rural regions, locally subsidized members had more than twice the odds of receiving hemodialysis compared with nationally subsidized members (aOR 2.40, 95% CI: 1.78-3.23). Men had higher odds than women (aOR 1.17, 95% CI: 1.04-1.32), and younger patients were more likely to receive treatment than older ones. Regional disparities were stark, with patients in Java or Bali having much greater access (aOR 8.30, 95% CI 5.33-12.94) compared with those in eastern Indonesia (Papua, Maluku, and Nusa Tenggara). Patients treated at private facilities (aOR 1.30, 95% CI 1.13-1.50) and in outpatient settings (aOR 3.74, 95% CI 3.36-4.17) were more likely to receive hemodialysis, whereas those in lower-level hospitals or clinics were less likely to access care. Conclusions: Substantial disparities in hemodialysis claim patterns (as a proxy for access) exist within Indonesia's national health insurance system, particularly affecting low-income populations, rural residents, women, and those in less advantaged regions. Policy efforts to enhance health infrastructure, improve service distribution, and reduce geographic and socioeconomic barriers are urgently needed to support equitable access to renal care services and achieve universal health coverage goals. (©Aries Munandar, Syarif R Hasibuan, Dian Kusuma. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 03.11.2025.) |
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| Contributed Indexing: | Keywords: BPJS Kesehatan; Indonesia; claims data; health equity; hemodialysis; kidney failure; national health insurance |
| Entry Date(s): | Date Created: 20251103 Date Completed: 20251103 Latest Revision: 20251123 |
| Update Code: | 20251123 |
| PubMed Central ID: | PMC12624297 |
| DOI: | 10.2196/73731 |
| PMID: | 41183316 |
| Databáze: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Background: Chronic kidney disease and end-stage renal disease are major contributors to the disease burden in low- and middle-income countries, including Indonesia. Despite the expansion of universal health coverage through Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, Indonesia's national health insurance program, disparities in access to hemodialysis persist across different socioeconomic and geographic groups. Understanding these inequities is critical to advancing equitable health care access.<br />Objective: This study aimed to examine disparities in hemodialysis claim patterns as a proxy for access among adult patients with renal failure enrolled in BPJS, focusing on differences by membership type, sex, age, geographic region, urbanicity, and facility ownership.<br />Methods: We conducted a cross-sectional analysis of 38,383 anonymized health insurance claims between 2017 and 2022 for patients with renal failure who were aged ≥18 years. The primary outcome was receipt of hemodialysis. We used multivariate logistic regression to estimate adjusted odds ratios (aORs) for receiving hemodialysis across BPJS membership types and other covariates. Subgroup analyses were performed by sex, facility ownership, urbanicity, and geographic region. Robust SEs and probability weights were applied to account for the sample design.<br />Results: Of the total renal failure claims, 75.6% (29,017/38,383) involved hemodialysis. Compared with individuals in the lowest income group (ie, members subsidized under the national government budget), informal workers (aOR 1.56, 95% CI: 1.34-1.82); P<.001) and members subsidized under the local government budget (aOR 1.31, 95% CI: 1.05-1.63); P=.017) had higher odds of receiving hemodialysis, while formal sector workers had lower odds (aOR 0.81, 95% CI: 0.68-0.98); P=.028). Disparities were more pronounced in rural areas and among women; for example, in rural regions, locally subsidized members had more than twice the odds of receiving hemodialysis compared with nationally subsidized members (aOR 2.40, 95% CI: 1.78-3.23). Men had higher odds than women (aOR 1.17, 95% CI: 1.04-1.32), and younger patients were more likely to receive treatment than older ones. Regional disparities were stark, with patients in Java or Bali having much greater access (aOR 8.30, 95% CI 5.33-12.94) compared with those in eastern Indonesia (Papua, Maluku, and Nusa Tenggara). Patients treated at private facilities (aOR 1.30, 95% CI 1.13-1.50) and in outpatient settings (aOR 3.74, 95% CI 3.36-4.17) were more likely to receive hemodialysis, whereas those in lower-level hospitals or clinics were less likely to access care.<br />Conclusions: Substantial disparities in hemodialysis claim patterns (as a proxy for access) exist within Indonesia's national health insurance system, particularly affecting low-income populations, rural residents, women, and those in less advantaged regions. Policy efforts to enhance health infrastructure, improve service distribution, and reduce geographic and socioeconomic barriers are urgently needed to support equitable access to renal care services and achieve universal health coverage goals.<br /> (©Aries Munandar, Syarif R Hasibuan, Dian Kusuma. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 03.11.2025.) |
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| ISSN: | 2369-2960 |
| DOI: | 10.2196/73731 |