TY - JOUR
T1 - Exploring Inequalities in the Use, Quality, and Outcome of the Diabetes Management Program of Indonesian National Health Insurance
AU - Mulyanto, Joko
AU - Wibowo, Yudhi
AU - Ernawati, Dwi Arini
AU - Lestari, Diyah Woro Dwi
AU - Kringos, Dionne S.
N1 - Funding Information: Joko Mulyanto received a research grant from the Institute of Research and Community Service, Universitas Jenderal Soedirman, which covered the data collection process (Grant number: T/864/UN23.18/PT.01.03/2021). Funding Information: The authors thank the Banyumas District Health Office and the District Office of Indonesia National Health Insurance in Banyumas for their support during the data collection process. Publisher Copyright: © Joko Mulyanto et al., 2023.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Introduction: Access to diabetes management programs is crucial to control the increasing contribution of diabetes to the global burden of disease. However, evidence regarding whether such services are equally accessible for all population groups is still lacking, particularly in the context of low-middle-income countries and under the National Health Insurance (NHI). This study aimed to assess the extent of socioeconomic and geographical inequalities in the use, quality, and outcome of a diabetes management program for beneficiaries of Indonesian NHI. Methods: A total of 628 participants in the NHI diabetes management program in Banyumas District, Indonesia, were included in 2021 in this cross-sectional study. The main variables measured were regular visits to primary care facilities, standard medication, and glycemic control. The rate difference and rate ratio of age-sex standardized prevalence rates, as well as multiple logistic regressions, were used to measure the extent of inequalities. Results: Around 70% of participants regularly visited primary care facilities and received standard medication, but only 35% had good glycemic control. Highly educated participants were more likely to have regular visits compared to low-educated participants (odds ratio [OR] 1.92; 95% confidence interval [95% CI]: 1.04–3.56). Based on employment and type of NHI beneficiaries, a small extent and even reverse inequalities were found although these findings were insignificant statistically. Urban residents were also more likely to have regular visits (OR 6.61; 95% CI: 2.90–15.08), receive standard medication (OR 9.73; 95% CI: 3.66–25.90), and have good glycemic control (OR 3.85; 95% CI: 1.68–8.83) compared to rural residents. Conclusions: Evidence on the extent of socioeconomic inequalities is inconclusive but substantial geographical inequalities in the use, quality, and outcome of diabetes management programs exist among Indonesian NHI beneficiaries. Future implementation policies of the program should consider particularly the geographical characteristics of participants to avoid and reduce inequalities and, hence, the disease burden of diabetes.
AB - Introduction: Access to diabetes management programs is crucial to control the increasing contribution of diabetes to the global burden of disease. However, evidence regarding whether such services are equally accessible for all population groups is still lacking, particularly in the context of low-middle-income countries and under the National Health Insurance (NHI). This study aimed to assess the extent of socioeconomic and geographical inequalities in the use, quality, and outcome of a diabetes management program for beneficiaries of Indonesian NHI. Methods: A total of 628 participants in the NHI diabetes management program in Banyumas District, Indonesia, were included in 2021 in this cross-sectional study. The main variables measured were regular visits to primary care facilities, standard medication, and glycemic control. The rate difference and rate ratio of age-sex standardized prevalence rates, as well as multiple logistic regressions, were used to measure the extent of inequalities. Results: Around 70% of participants regularly visited primary care facilities and received standard medication, but only 35% had good glycemic control. Highly educated participants were more likely to have regular visits compared to low-educated participants (odds ratio [OR] 1.92; 95% confidence interval [95% CI]: 1.04–3.56). Based on employment and type of NHI beneficiaries, a small extent and even reverse inequalities were found although these findings were insignificant statistically. Urban residents were also more likely to have regular visits (OR 6.61; 95% CI: 2.90–15.08), receive standard medication (OR 9.73; 95% CI: 3.66–25.90), and have good glycemic control (OR 3.85; 95% CI: 1.68–8.83) compared to rural residents. Conclusions: Evidence on the extent of socioeconomic inequalities is inconclusive but substantial geographical inequalities in the use, quality, and outcome of diabetes management programs exist among Indonesian NHI beneficiaries. Future implementation policies of the program should consider particularly the geographical characteristics of participants to avoid and reduce inequalities and, hence, the disease burden of diabetes.
KW - Indonesia
KW - National Health Insurance
KW - diabetes mellitus
KW - disease management
KW - glycemic control
KW - inequalities
UR - http://www.scopus.com/inward/record.url?scp=85173222707&partnerID=8YFLogxK
U2 - https://doi.org/10.1089/heq.2023.0025
DO - https://doi.org/10.1089/heq.2023.0025
M3 - Article
C2 - 37786529
SN - 2473-1242
VL - 7
SP - 644
EP - 652
JO - Health Equity
JF - Health Equity
IS - 1
ER -