Utilization patterns of healthcare facility and estimated expenditure of PLHIV care under the Indonesian National Health Insurance Scheme in 2018

• Published in: BMC health services research 2022-01, Vol.22 (1), p.97-97, Article 97
• Main Authors: Setiawan, Ery, Nurjannah, Nurjannah, Komaryani, Kalsum, Nugraha, Ryan Rachmad, Thabrany, Hasbullah, Purwaningrum, Farah, Sarnianto, Prih
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral drugs; Capitation; Care and treatment; Datasets; Demographic aspects; Diagnosis related groups; DRGs; Economic aspects; Expenditures; Financing; Funding; Health economics; Health Expenditures; Health facilities; Health insurance; Health services utilization; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV patients; Homeopathy; Human immunodeficiency virus; Humans; Indonesia - epidemiology; Insurance coverage; Insurance, Health; JKN; Materia medica and therapeutics; Measurement; Medical care, Cost of; National health insurance; National Health Programs; Payment systems; PHLIV; Population; Primary care; Therapeutics; Universal Health Insurance
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-07434-9

This study analyzed current patterns of service use, referral, and expenditure regarding HIV care under the National Health Insurance Scheme (JKN) to identify opportunities to improve HIV treatment coverage. As of September 2020, an estimated 543,100 people in Indonesia were living with HIV, but only 352,670 (65%) were aware of their status, and only 139,585 (26%) were on treatment. Furthermore, only 27,917 (4.5%) viral load (VL) tests were performed. Indonesia seeks to broaden its HIV response. In doing so, it intends to replace declining donor-funding through better coverage of HIV/AIDS services by its JKN. Thus, this study aims to assess the current situation about HIV service coverage and expenditure under a domestic health-insurance funded scheme in Indonesia. This study employs a quantitative method by way of a cross-sectional approach. The 2018 JKN claims data, drawn from a 1% sample that JKN annually produces, were analyzed. Nine hundred forty-five HIV patients out of 1,971,744 members were identified in the data sample and their claims record data at primary care and hospital levels were analyzed. Using ICD (International Statistical Classification of Diseases and Related Health Problems), 10 codes (i.e., B20, B21, B22, B23, and B24) that fall within the categories of HIV-related disease. For each level, patterns of service utilization by patient-health status, discharge status, severity level, and total cost per claim were analyzed. Most HIV patients (81%) who first seek care at the primary-care level are referred to hospitals. 72.5% of the HIV patients receive antiretroviral treatment (ART) through JKN; 22% at the primary care level; and 78% at hospitals. The referral rate from public primary-care facilities was almost double (45%) that of private providers (24%). The most common referral destination was higher-level hospitals: Class B 48%, and Class C 25%, followed by the lowest Class A at 3%. Because JKN pays hospitals for each inpatient admission, it was possible to estimate the cost of hospital care. Extrapolating the sample of hospital cases to the national level using the available weight score, it was estimated that JKN paid IDR 444 billion a year for HIV hospital services and a portion of capitation payment. There was an underrepresentation of PLHIV (People Living with HIV) who had been covered by JKN as 25% of the total PLHIV on ART were able to attain access through other schemes. This study finding is principally aligned with other lo