Impact of health security system reform on facility based delivery utilization in Indonesia

Abstract

Delivery in health facility enables women and infant to receive proper medical attention and care that help to reduce maternal and neonatal mortality and morbidity. However, many women cannot afford the cost of facility-based delivery particularly those who are poor. In order to reduce financial hardship as a consequence of health expenditure, Indonesia has attempted to reform its health security system since 2005. There is limited study ab out the impact of health security system reform on utilization of facility-based delivery. This study aims to investigate the impact of health security system reform on facility-based delivery utilization in Indonesia and explore associated factors of the use of facility based delivery. This study employed pooled time series data from Indonesia's Family Life Survey (IFLS) wave 2 to 5, which collected information of births during the period of 1992-2015. The study focused on births given by ever married women aged 15-49 years in Indonesia. The analysis included 16,673 eligible births that occurred FROM 1992 to 2015. Facility based delivery was measured by place of delivery. Delivery in both public and private health facilities was defined as facility-based delivery. The time of implementation of health security reform was measured by the year of implementation which took place in 2005 (ASKESKIN) 2011 (JAMPERSAL), and 2015 (JKN). Factors associated with facility-based delivery consist of redisposing, enabling and need factors. Descriptive statistics, chi square test and multivariate analysis using generalized estimating equation (GEE) were applied. It was found that facility-based delivery (FBD) has increased from 50.1% to 83.7% over the period of health security reform (1992-2015). It increased from 50.1% to 66.4% after ASKESKIN scheme was implemented in 2005, raised up to 80.5% after implementing JAMPERSAL scheme and it increased to 83.7% after implementing JKN scheme. The result of generalized estimating equation also confirmed that after implementation of ASKESKIN in 2005 the odds of FBD was increased 1.640 times, it also continued increasing after JAMPERSAL with the odds of 3.245, and after JKN the odds of FBD increased to 4.390 when compared with before the reform of health security system. The study suggests that health security system implementation provides a supportive environment that encourages women to deliver their children in health facilities. Thus a continuation to expand the coverage of health security to achieve universal health coverage should be recommended.