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Original research
Associations between Indonesia’s national health insurance, effective coverage in maternal health and neonatal mortality: a multilevel interrupted time-series analysis 2000–2017
  1. Tiara Marthias1,2,
  2. Barbara McPake1,
  3. Natalie Carvalho3,
  4. Christopher Millett4,5,
  5. Kanya Anindya1,
  6. Nurmala Selly Saputri6,
  7. Laksono Trisnantoro2,
  8. John Tayu Lee1,4,7
  1. 1 Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  3. 3 Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Department of Primary Care and Public Health, Imperial College London, London, UK
  5. 5 Comprehensive Health Research Center and Public Health Research Centre, National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
  6. 6 The SMERU Research Institute, Jakarta, Indonesia
  7. 7 Department of Health Service Research and Policy, Australia National University, Canberra, Canberra, Australia
  1. Correspondence to Dr Tiara Marthias, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; tiara.marthias{at}unimelb.edu.au

Abstract

Background We assessed the effect of Indonesia’s national health insurance programme (Jaminan Kesehatan Nasional (JKN)) on effective coverage for maternal and child health across geographical regions and population groups.

Methods We used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15–49 years and 144 000 birth records. Key outcomes included antenatal and delivery care, caesarean section and neonatal and infant mortality. We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014.

Findings JKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation.

Interpretation Expansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.

  • MATERNAL HEALTH
  • INFANT MORTALITY
  • CHILD HEALTH
  • HEALTH POLICY

Data availability statement

Data are available in a public, open access repository. The data sets are publicly accessible after registration (https://www.dhsprogram.com).

https://doi.org/10.1136/jech-2021-217213

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    Data availability statement

    Data are available in a public, open access repository. The data sets are publicly accessible after registration (https://www.dhsprogram.com).

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    Footnotes

    • Twitter @timarthias

    • Contributors The aim of the research was developed by TM, BM, NC and JTL. The methodology development and analysis were conducted by TM, KA and JTL. NSS and KA assisted in drafting the introduction and discussion sections and proofread all sections. TM drafted the manuscript and is responsible for the overall content. LT, BM, NC, CM and JTL contributed to the background and discussion sections. All authors reviewed, edited and commented on multiple versions of the manuscript.

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    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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