Factors associated with the utilization of primary health care under National Health Insurance (NHI) in Samarinda municipality, East Kalimantan province, Indonesia

Abstract

National Health Insurance (NHI) is compulsory social health insurance in Indonesia providing health insurance to fulfill community health basic needs for participants. Health services for NHI participants are provided by primary health care (PHC) providers such as those who serve at Community Health Centres (Puskesmas), primary clinics and general practitioners using a Gatekeeper arrangement. Although PHC in Indonesia is available in rural and urban areas, utilization of PHC is low compared to that of higher levels of health facilities. This cross-sectional study aimed at assessing factors associated with utilization at primary health care under NHI in Samarinda Municipality, East Kalimantan Province, Indonesia. A total of 382 respondents of NHI participants aged more than 18 years and above who had experience in utilizing PHC at least once were recruited into the study. The utilization of PHC was assessed using structured questionnaires consisting of six dimensions; accessibility, availability, acceptability, affordability, accommodation, and awareness. Association between variables was analyzed using univariate and multiple logistics regression. The result shows that overall regular utilization was 17.3 percent among NHI participants. Type of NHI, accommodation, and awareness were found to be associated with the utilization of PHC. Those who were in the non-PBI group had odds of 2.6 times to utilize PHC than those in the PBI group (adjusted OR 2.628, 95% CI; 1.346:5.129, p-value 0.005). Regarding people who had the highest level of accommodation had odds of 2.18 times to utilize in the PHC than other groups (adjusted OR 2.181, 95% CI; 1.052:4.522, p-value 0.036). Moreover, respondents with a high level of awareness had odds of 3 times to utilize PHC than other levels (adjusted OR 3.278, 95 % CI; 1.572:6.833, p-value 0.002). The study suggests that policymakers and primary health care providers promote and encourage PHC and NHI to provide online application or use telephone for appointment with facilitator and provide sufficient and accurate information on PHC and NHI, as well as focus on counseling by health personnel. IMPLICATION OF THEMATIC PAPER Further studies should be conducted in other countries or other regions of Indonesia, and should be further explored on utilization of PHC by using other conceptual theories.