Indonesia’s National Health Insurance Policy Reform and Enhanced Physical Abilities in People with Physical Disabilities: A Policy Analysis

Abstract

Indonesia, confronting a significant population grappling with disabilities, has witnessed a surge in disability prevalence, prompting a call for comprehensive health solutions. The 2014 initiation of the Social Security Agency on Health, or Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) program, aims to alleviate financial burdens and enhance overall health, specifically targeting persons with disabilities (PwD). Health insurance reforms, with a focus on expanding coverage for rehabilitation services and assistive devices, harbor the potential to ameliorate the physical abilities of PwD in daily life activities. However, the specific impact of these reforms on the functional abilities of individuals with disabilities, particularly in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), remains underexplored. This study investigates outcomes related to physical abilities before and after the implementation of the National Health Insurance policy by utilizing secondary data from the Indonesian Family Life Survey (IFLS). The analysis focuses on 2,296 disabled individuals from IFLS4 (pre-reform) and 3,463 from IFLS5. Physical abilities were measured through ADL and IADL exercises, employing logistic regression models to assess the impact of Jaminan Kesehatan Nasional implementation on the abilities of PwDs, adjusting for potential confounders. In 2015, a higher percentage of participants reported good physical ability compared to 2008, signifying a potential improvement following the reform. Observations included shifts in education levels, marital status, and residence, with an inclination toward higher education, diverse marital statuses, and a reduction in rural participants in 2015. A noteworthy increase in participants with health insurance in 2015 compared to 2008 was observed. The distribution of health conditions changed, indicating an increase in healthy participants and a decrease in unhealthy participants in 2015 (adjusted odds ratio [aOR]: ADL 6.16, 95% confidence interval [CI]: 4.41-8.63; IADL 3.39, 95% CI: 2.71-4.25). The implementation of the BPJS program positively impacted the physical abilities and overall conditions of individuals with disabilities. Emphasis was placed on the role of accessible healthcare services, the importance of insurance coverage, and the necessity for evidence-based policies promoting inclusivity and equity. Policymakers were urged to prioritize initiatives supporting the well-being of individuals with disabilities in Indonesia. The study also outlined limitations and suggested future research directions for a more comprehensive understanding of factors influencing physical abilities in this population.