The Impact on Healthcare System Reform of National Health Insurance on Physical Ability of Disabled People using IFLS Data

Abstract

Background: Indonesia's number of people with disabilities (PwD) reaches 30.38 million or around 14.2%, based on the National Socio-Economic Survey (SUSENAS), 2018. Most of them face difficulty with activities of daily living (ADLs) and difficulties in performing activities to live independently in a community (IADL). The Indonesian government and MoH worked to reduce this inequality with the implementation of BPJS Health in 2014. However, most existing studies in Indonesia just explore the impact of UHC in general, not specifically mentioned disability. Therefore, the study on accessibility, health outcomes, and health activities, is surprisingly somewhat limited and recent. Objective: To determine whether there was a positive influence of the National Health Insurance Program (JKN) on body functions and disability conditions of persons with disabilities in Indonesia. In addition, to provide a structure for implementing disability policies to meet the welfare of Persons with Disabilities in Indonesia. Methods: This study is quantitative research with a cross-sectional design, uses secondary data analysis using the Indonesian Family Life Survey (IFLS) 4 in 2007-2008 and IFLS5 in 2014-2015. The number of people with disabilities as respondents from IFLS 2007 was 2296 people, and IFLS 2008 was 3463 respondents. Analysis of the pre and post health insurance program for BPJS implementation was obtained from the Physical Ability checklist in the Daily Activities and Community Activities section by giving a score for each question that could be answered. The diverseness of the BPJS effect was explored based on socioeconomic statuses, such as area of residence in urban or rural areas, age, gender, marital status, educational background, and general health condition. Data were examined by binary logistic regression analysis using SPSS version 25. Results: Overall, there is a significant relationship between insurance status and improvement in the physical abilities of persons with disabilities before and after health system reform in Indonesia. With the existence of BPJS, people with disabilities who have difficulty doing ADL and IADL have 6.16 and 3.4 times more likely to have a healthy general condition than before BPJS was implemented. Conclusion: The implementation of Health insurance in Indonesia is quite good but needs improvement. For Indonesia's future research and policy direction, the GoI must address health inequalities for individuals with disabilities. By increasing access and health services, increasing disability data to support decision making, strengthening the capacity of health workers and human services, especially in the field of orthotic prosthetics in rural areas, the quality of UHC in Indonesia can be achieved well. In addition, it would be beneficial to provide an explicit public health program related to disability inclusion, having automatic participation for all citizens through simplification and refocusing of BPJS coverage.