Examining Equity in Healthcare Services among Beneficiaries of the National Health Insurance Program in Indonesia: Evidence from National Survey

Introduction: Equity is one of the most prominent health issues globally. Indonesia has been implementing national health insurance as a strategy toward Universal Health Coverage to expand health coverage without financial hardship to access health care services. The equity evaluation is needed after 5-years of implementation. This study aimed to describe healthcare equity among national health insurance beneficiaries. Methods: Cross-sectional data from National Socio-Economic Survey in Indonesia between 2014 and 2018 were used. To measure health care utilisation, we used outpatient visits and inpatient admission. A descriptive analysis was conducted, equity analysis using concentration index by region and economic status, and logistic regression to explore the factors determining health care utilisation. Results: The national outpatient and inpatient care concentration Index dropped from 0.042 to 0.021 and 0.199 to 0.118, respectively. The equity gap among regions also decreased over time. Outpatient care utilisation fluctuate between 13.3% to 17%, while inpatient care utilisation increased from 2.5% to 4.7% in 2018. Health complaints, non-subsidised health insurance scheme and high socioeconomic were factors determining outpatient and inpatient care utilisation. Conclusion: Equity of outpatient and inpatient care among health insurance beneficiaries improved. However, we found less equity in the inpatient care which concentrated on better-off groups.