Health Services Evaluation

ABSTRAK Latar Belakang: Asuransi kesehatan diketahui dapat meningkatkan pemanfaatan pelayanan kesehatan, alasan tersebut mendorong pemerintah merilis kebijakan Jaminan Kesehatan Nasional. Tujuan: Penelitian ditujukan untuk menganalisis hubungan asuransi kesehatan dengan pemanfaatan Puskesmas di Probolinggo-Jawa Timur. Metode: Penelitian mengekstraksi data Riset Kesehatan Dasar (Riskesdas) tahun 2018. Riskesdas menggunakan stratifikasi dan multistage random sampling untuk memilih sampel, sehingga studi ini dapat menganalisis 3.393 responden (≥ 15 tahun) di Probolinggo-Jawa Timur. Selain pemanfaatan Puskesmas sebagai variabel outcome, penelitian menggunakan kepemilikas asuransi kesehatan sebagai variabel terpapar, dan sembilan variabel lain sebagai kontrol: area, tempat tinggal, umur, jenis kelamin, perkawinan, pendidikan, pekerjaan, sosio-ekonomi, dan waktu tempuh ke Puskesmas. Regresi logistik biner digunakan untuk penentuan pada tahap akhir. Hasil: Hasil penelitian menemukan bahwa bahwa mereka yang memiliki asuransi kesehatan yang dikelola pemerintah memiliki peluang 2,371 kali dibanding yang tidak memiliki asuransi kesehatan untuk memanfaatkan Puskesmas (AOR 2,371; 95% CI 2,320-2,423). Lebih lanjut, mereka yang memiliki asuransi kesehatan yang dikelola pemerintah dan juga swasta memiliki peluang 1,924 kali dibanding yang tidak memiliki asuransi kesehatan untuk memanfaatkan Puskesmas (AOR 1,924; 95% CI 1,829-2,024). Kesimpulan: Dapat disimpulkan bahwa kepemilikan asuransi kesehatan memiliki keterkaitan dengan pemanfaatan Puskesmas di Probolinggo. Mereka yang memiliki asuransi kesehatan yang dikelola oleh pemerintah memiliki peluang paling tinggi untuk memanfaatkan pelayanan Puskesmas. Kata kunci: asuransi kesehatan, Puskesmas, pelayanan kesehatan, pemanfaatan pelayanan kesehatan, pelayanan kesehatan dasar. ABSTRACT Background: Health insurance is known to increase the utilization of health services, prompting the government to release a National Health Insurance policy. Objective: This study aimed to analyze the relationship between health insurance and the utilization of the Puskesmas in Probolinggo-East Java. Methods: The study extracted data from the 2018 Basic Health Research (Riskesdas). Riskesdas used stratification and multistage random sampling to select samples, so this study could analyze 3,393 respondents (≥ 15 years) in Probolinggo-East Java. In addition to the utilization of the Puskesmas as an outcome variable, the study used the owner of health insurance as an exposed variable and nine other variables as controls: area, place of residence, age, gender, marriage, education, occupation, socio-economics, and travel time to the Puskesmas. Binary logistic regression was used for determination at the final stage. Results: The study found that those who had health insurance managed by the government had 2.371 times more chance than those who did not have health insurance to take advantage of the Puskesmas (AOR 2.371; 95% CI 2.320-2.423). Furthermore, those who have public and private health insurance have a 1.924 times chance than those who do not have health insurance to take advantage of the Puskesmas (AOR 1.924; 95% CI 1.829-2.024). Conclusion: The study concluded that the ownership of health insurance is related to using the Puskesmas in Probolinggo. Those with health insurance managed by the government have the highest opportunity to take advantage of Puskesmas services.

Background An urban poor is a vulnerable group that needs government financing support to access health services. Once they are sick, they will fall deeper into poverty. The study aims to analyze the effectiveness of government-run insurance in hospital utilization in urban poor in Indonesia. Methods The research analyzed the 2018 Indonesian Basic Health Survey data. This cross-sectional survey collected 75,970 participants through stratification and multistage random sampling. Meanwhile, the study employed hospital utilization as an outcome variable and health insurance ownership as an exposure variable. Moreover, the study looked at age, gender, marital status, education, and occupation as control factors. The research employed a binary logistic regression to evaluate the data in the final step. Results The results show that someone with government-run insurance is 4.261 times more likely than the uninsured to utilize the hospital (95% CI 4.238–4.285). Someone with private-run insurance is 4.866 times more likely than the uninsured to use the hospital (95% CI 4.802–4.931). Moreover, someone with government-run and private-run insurance has 11.974 times more likely than the uninsured to utilize the hospital (95% CI 11.752–12.200). Conclusion The study concluded that government-run insurance is more effective than the uninsured in improving hospital utilization among the urban poor in Indonesia. Meanwhile, private-run is more effective than government-run and uninsured in improving hospital utilization among the urban poor in Indonesia. Moreover, the most effective is to combine the kind of health insurance ownership (government-run and private-run).

Objectives Policymakers must ensure that the entire population has equal access to health services, and efforts to minimise inequalities are needed. This study aimed to analyse the regional disparities in hospital utilisation in Indonesia. Design A cross-sectional study analysing secondary data from the 2018 Indonesian Basic Health Survey. Setting National-level survey data from Indonesia. Participants A total of 629 370 participants were included in the study. Intervention We employed no intervention Primary and secondary outcome measures The primary outcome was hospital utilisation. Aside from region, we utilise residence type, age, gender, marital status, educational level, occupation, wealth, insurance and travel time as control variables. We used binary logistic regression in the final analysis Results The respondents in Sumatra were 1.079 times (95% CI 1.073 to 1.085) more likely than those in Papua to use the hospital. Furthermore, compared with the respondents in Papua, those in the Java–Bali region (1.075 times, 95% CI 1.069 to 1.081), Nusa Tenggara (1.106 times, 95% CI 1.099 to 1.113), Sulawesi (1.008 times, 95% CI 1.002 to 1.014) and Kalimantan (1.212 times, 95% CI 1.205 to 1.219) were more likely to use the hospital. However, those in Maluku were less likely than those in Papua to use the hospital (0.827 times, 95% CI 0.820 to 0.835). Six demographic variables (age, gender, marital status, educational level, occupation and wealth) and three other control variables (residence type, insurance and travel time to the hospital) were found to be associated with hospital utilisation. Conclusions Our findings highlight the existence of regional disparities in hospital utilisation in Indonesia.

Background The disadvantaged areas are one of the government’s focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia. Methods The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data. Results The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032–1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639–1.673). Moreover, the study found marital status has a relationship with hospital utilization. The higher the education level, the higher the hospital utilization. Employed individuals have a 0.748 possibility to use the hospital compared with those unemployed (95% CI 0.740–0.757). Wealthy individuals have more chances of using the hospital than poor individuals. Individuals with all insurance types are more likely to utilize the hospital than those uninsured. Individuals with travel times of ≤ 1 h are 2.510 more likely to use the hospital than those with > 1 h (95% CI 2.483–2.537). Conclusion The specific targets to accelerate the increase in hospital utilization in disadvantaged areas in Indonesia are living in a rural area, being male, never in a union, having no education, being employed, being the poorest, uninsured, and having a travel time of > 1 h. The government should make a policy addressing the problem based on the research findings.

Background: The border area in Indonesia is often neglected, apart from remote locations and islands. Aims: The study aims to analyze the role of borderlands status on hospital utilization on Kalimantan Island, Indonesia. Methods: The study was a cross-sectional study. The research obtained 61,598 respondents through stratification and multistage random sampling-the study employed hospital utilization as an outcome variable; meanwhile, borderlands status as an exposure variable. Moreover, the study used nine control variables: residence type, age group, gender, marital status, education level, occupation type, wealth status, health insurance ownership, and travel time to the hospital. The study employed binary logistic regression to analyze the data in the last stage. Results: The results show that the average hospital utilization in Kalimantan Island in 2018 in this study was 4.953%. Meanwhile, those who live in the border area have 1.406 times the probability of utilizing the hospital than those in the nor-border area (95% CI 1.392-1.419). On the other hand, the study analysis also found all control variables were significantly related to hospital utilization: residence type, age group, gender, marital status, education level, occupation type, wealth status, health insurance ownership, and travel time to the hospital. Conclusion: The study concludes that borderlands status is related to hospital utilization on Kalimantan Island. Those who live in border areas have a better possibility of hospital utilization than those in non-border areas.

Background: Primary Health Care utilization is one of the indicators to evaluate healthcare system performance. The study aims to analyze the target for accelerating Primary Health Care utilization among adults in East Java, Indonesia. Methods: The study employed secondary data from the 2018 Indonesian Basic Health Survey. The survey analyzed 68,747 respondents. In addition to Primary Health Care utilization as a dependent variable, the study uses residence, age, gender, marital, education, employment, wealth, health insurance, and time travel as independent variables. The study used binary logistic regression in the final step. Results: Adults living in urban areas have a possibility of 1.064 times than those living in rural areas to utilize Primary Health Care. Age correlated to immediate health care utilization, and females have a better opportunity in direct health care utilization. According to marital status, divorced/widowed have the chance of 2.070 times than never in a union to use Primary Health Care. The better the education level, the lower the direct health care utilization. Employment and wealth status correlated to immediate health care utilization. According to health insurance ownership, government-run insurance has the highest chance to use Primary Health Care. The ≤ 10 minutes is a protective factor for adults to use Primary Health Care. Conclusion: The target for a policy acceleration of Primary Health Care utilization among adults in East Java has nine characteristics: lives in rural areas, old, male, divorced/widowed, well educated, employed, the poorest, uninsured, and have time travel more than 10 minutes.

ABSTRAK Latar Belakang: Asuransi kesehatan diketahui dapat meningkatkan pemanfaatan pelayanan kesehatan, alasan tersebut mendorong pemerintah merilis kebijakan Jaminan Kesehatan Nasional. Tujuan: Penelitian ditujukan untuk menganalisis hubungan asuransi kesehatan dengan pemanfaatan Puskesmas di Probolinggo-Jawa Timur. Metode: Penelitian mengekstraksi data Riset Kesehatan Dasar (Riskesdas) tahun 2018. Riskesdas menggunakan stratifikasi dan multistage random sampling untuk memilih sampel, sehingga studi ini dapat menganalisis 3.393 responden (≥ 15 tahun) di Probolinggo-Jawa Timur. Selain pemanfaatan Puskesmas sebagai variabel outcome, penelitian menggunakan kepemilikas asuransi kesehatan sebagai variabel terpapar, dan sembilan variabel lain sebagai kontrol: area, tempat tinggal, umur, jenis kelamin, perkawinan, pendidikan, pekerjaan, sosio-ekonomi, dan waktu tempuh ke Puskesmas. Regresi logistik biner digunakan untuk penentuan pada tahap akhir. Hasil: Hasil penelitian menemukan bahwa bahwa mereka yang memiliki asuransi kesehatan yang dikelola pemerintah memiliki peluang 2,371 kali dibanding yang tidak memiliki asuransi kesehatan untuk memanfaatkan Puskesmas (AOR 2,371; 95% CI 2,320-2,423). Lebih lanjut, mereka yang memiliki asuransi kesehatan yang dikelola pemerintah dan juga swasta memiliki peluang 1,924 kali dibanding yang tidak memiliki asuransi kesehatan untuk memanfaatkan Puskesmas (AOR 1,924; 95% CI 1,829-2,024). Kesimpulan: Dapat disimpulkan bahwa kepemilikan asuransi kesehatan memiliki keterkaitan dengan pemanfaatan Puskesmas di Probolinggo. Mereka yang memiliki asuransi kesehatan yang dikelola oleh pemerintah memiliki peluang paling tinggi untuk memanfaatkan pelayanan Puskesmas. ABSTRACT Background: Health insurance is known to increase the utilization of health services, prompting the government to release a National Health Insurance policy. Aims: This study aimed to analyze the relationship between health insurance and the utilization of the Puskesmas in Probolinggo-East Java. Methods: The study extracted data from the 2018 Basic Health Research (Riskesdas). Riskesdas used stratification and multistage random sampling to select samples, so this study could analyze 3,393 respondents (≥ 15 years) in Probolinggo-East Java. In addition to the utilization of the Puskesmas as an outcome variable, the study used the owner of health insurance as an exposed variable and nine other variables as controls: area, place of residence, age, gender, marriage, education, occupation, socio-economics, and travel time to the Puskesmas. Binary logistic regression was used for determination at the final stage. Results: The study found that those who had health insurance managed by the government had 2.371 times more chance than those who did not have health insurance to take advantage of the Puskesmas (AOR 2.371; 95% CI 2.320-2.423). Furthermore, those who have public and private health insurance have a 1.924 times chance than those who do not have health insurance to take advantage of the Puskesmas (AOR 1.924; 95% CI 1.829-2.024). Conclusion: The study concluded that the ownership of health insurance is related to using the Puskesmas in Probolinggo. Those with health insurance managed by the government have the highest opportunity to take advantage of Puskesmas services.

Objective Policymakers must ensure that the entire population has equal access to health services. Efforts to minimize inequalities are a necessity. This study aimed to analyze the regional disparities in hospital utilization in Indonesia. Design This is a cross-sectional study. It analyzed secondary data from the 2018 Indonesian Basic Health Survey. Setting The study was conducted in Indonesia at the national level. Participants A total of 629,370 participants were included in this study. Methods This study included 629,370 respondents through stratification and multistage random sampling. Aside from region and hospital utilization, residence type, age, gender, marital status, educational level, occupation, wealth, insurance, and travel time were used as control variables. To analyze the data, binary logistic regression was employed. Results The respondents in Sumatra were 1.079 times (95% confidence interval (CI) 1.073-1.085) more likely than those in Papua to utilize the hospital. Furthermore, compared with the respondents in Papua, those in the Java-Bali region (1.075 times, 95% CI 1.069-1.081), Nusa Tenggara (1.106 times, 95% CI 1.099-1.113), Sulawesi (1.008 times, 95% CI 1.002-1.014), and Kalimantan (1.212 times, 95% CI 1.205-1.219) were more likely to utilize the hospital. However, those in Maluku were only 0.827 (95% CI 0.820-0.835) times as likely as those in Papua to utilize the hospital. This study also found six demographic variables related to hospital utilization, namely, age, gender, marital status, educational level, occupation, and wealth, as well as three control variables, namely, residence type, insurance, and travel time to the hospital. Conclusion This study concluded that there are regional disparities in hospital utilization in Indonesia.

ARTICLE INFO ABSTRAK Sosio-ekonomi memiliki peranan dalam menentukan prioritas individu untuk memenuhi kebutuhannya, termasuk untuk kesehatan. Penelitian ditujukan untuk menganalisis peran tingkat sosio-ekonomi dalam pemanfaatan Puskesmas Pasuruan di Jawa Timur. Penelitian potong-lintang ini menganalisis data sekunder dari Riset Kesehatan Dasar tahun 2018. Dengan metode stratifikasi dan multistage random sampling, penelitian ini merekrut 3.352 responden di Pasuruan, Jawa Timur sebagai sampel. Selain pemanfaatan Puskesmas sebagai variabel outcome dan tingkat sosio-ekonomi sebagai variabel terpapar, penelitian juga menganalisis sembilan variabel kontrol (kabupaten, tempat tinggal, umur, jenis kelamin, perkawinan, pendidikan, pekerjaan, asuransi kesehatan, dan waktu tempuh ke Puskesmas). Data dianalisis menggunakan regresi logistik biner. Hasil penelitian menemukan bahwa penduduk Pasuruan yang miskin memiliki kemungkinan 1,765 kali lebih tinggi dibanding yang paling miskin untuk memanfaatkan pelayanan Puskesmas (AOR 1,765; 95% CI 1,726-1,806). Penduduk Pasuruan yang memiliki sosio-ekonomi menengah kemungkinan 1,286 kali lebih tinggi dibanding yang paling miskin untuk memanfaatkan pelayanan Puskesmas (AOR 1,286; 95% CI 1,256-1,317). Penduduk Pasuruan yang kaya memiliki kesempatan 1,374 kali lebih tinggi dibanding yang paling miskin untuk memanfaatkan pelayanan Puskesmas (AOR 1,374; 95% CI 1,342-1,407). Lebih lanjut, penduduk Pasuruan yang paling kaya memiliki kemungkinan 0,634 kali dibanding yang paling miskin untuk memanfaatkan pelayanan Puskesmas (AOR 0,634; 95% CI 0,618-0,660). Dapat disimpulkan bahwa seluruh tingkat sosio-ekonomi memiliki kemungkinan lebih tinggi dalam memanfaatkan Puskesmas di Pasuruan. Kecuali, kelompok paling kaya, yang memiliki kemungkinan lebih rendah dalam memanfaatkan Puskesmas di Pasuruan. Untuk meningkatkan utilitas Puskesmas, pengambil kebijakan perlu memberi perhatian lebih pada masyarakat paling kaya.

Abstrak Latar Belakang: Madura adalah wilayah yang seringkali tertinggal dalam bidang Kesehatan di Jawa Timur, termasuk pemanfaatan pelayanan kesehatan. Tujuan: Penelitian ditujukan untuk menganalisis faktor-faktor yang berkaitan dengan pemanfaatan Puskesmas di Pulau Madura. Metode: Penelitian dengan desain potong lintang ini menganalisis data Riset Kesehatan Dasar (Riskesdas) tahun 2018. Dengan metode stratifikasi dan multistage random sampling, penelitian ini menganalisis 7.239 responden di Pulau Madura, Jawa Timur, sebagai sampel. Selain pemanfaatan Puskesmas sebagai variabel outcome dan tingkat pendidikan sebagai variabel terpapar, penelitian ini juga menganalisis sembilan variabel kontrol: kabupaten, tempat tinggal, umur, jenis kelamin, perkawinan, pekerjaan, sosio-ekonomi, asuransi kesehatan, dan waktu tempuh ke Puskesmas. Pada tahap final, data dianalisis menggunakan regresi logistik biner. Hasil: Hasil penelitian menemukan bahwa mereka yang berpendidikan SD-SLTP memiliki kemungkinan 1,213 kali dibanding yang tidak sekolah untuk memanfaatkan pelayanan Puskesmas (AOR 1,213; 95% CI 1,196-1,230). Mereka yang berpendidikan SLTA memiliki kemungkinan 0,976 kali dibanding yang tidak sekolah untuk memanfaatkan pelayanan Puskesmas (AOR 0,976; 95% CI 0,955-0,997). Lebih lanjut, mereka yang berpendidikan PT memiliki kemungkinan 0,222 kali dibanding yang tidak sekolah untuk memanfaatkan pelayanan Puskesmas (AOR 0,222; 95% CI 0,211-0,233). Selain tingkat pendidikan, sembilan variabel kontrol juga ditemukan berkaitan dengan pemanfaatan Puskesmas di Pulau Madura. Kesimpulan: Berdasarkan hasil penelitian, dapat disimpulkan bahwa tingkat pendidikan berkaitan dengan pemanfaatan Puskesmas di Pulau Madura. Abstract Background: Madura is an area that is often left behind in the health sector in East Java, including health services utilization. Objective: The study aims to analyze the factors related to the Puskesmas utilization on Madura Island. Method: This cross-sectional study analyzed the 2018 Indonesia Basic Health Survey (Riskesdas) data. The study analyzed 7,239 respondents on Madura Island, East Java, as a sample using the stratification method and multistage random sampling. In addition to the Puskesmas utilization as an outcome variable and education level as an exposed variable, this study also analyzed nine control variables: district, residence, age, gender, marriage, occupation, socio-economics, insurance, and travel time. The study analyzed data using binary logistic regression. Result: The study found that those with elementary-junior high school education were 1.213 times more likely than those who did not go to school to take advantage of Puskesmas services (AOR 1.213; 95% CI 1.196-1.230). Those with high school education were 0.976 times more likely than those without school to use the Puskesmas services (AOR 0.976; 95% CI 0.955-0.997). Furthermore, those with higher education were 0.222 times more likely than those not in school to take advantage of Puskesmas services (AOR 0.222; 95% CI 0.211-0.233). Apart from education level, nine control variables were also found to be related to the utilization of Puskesmas on Madura Island. Conclusion: The study concluded the education level is related to the Puskesmas utilization on Madura Island.

Latar Belakang: Madura adalah wilayah yang seringkali tertinggal dalam bidang Kesehatan di Jawa Timur, termasuk pemanfaatan pelayanan kesehatan. Tujuan: Penelitian ditujukan untuk menganalisis faktor-faktor yang berkaitan dengan pemanfaatan Puskesmas di Pulau Madura. Metode: Penelitian dengan desain potong lintang ini menganalisis data Riset Kesehatan Dasar (Riskesdas) tahun 2018. Dengan metode stratifikasi dan multistage random sampling, penelitian ini menganalisis 7.239 responden di Pulau Madura, Jawa Timur, sebagai sampel. Selain pemanfaatan Puskesmas sebagai variabel outcome dan tingkat pendidikan sebagai variabel terpapar, penelitian ini juga menganalisis sembilan variabel kontrol: kabupaten, tempat tinggal, umur, jenis kelamin, perkawinan, pekerjaan, sosio-ekonomi, asuransi kesehatan, dan waktu tempuh ke Puskesmas. Pada tahap final, data dianalisis menggunakan regresi logistik biner. Hasil: Hasil penelitian menemukan bahwa mereka yang berpendidikan SD-SLTP memiliki kemungkinan 1,213 kali dibanding yang tidak sekolah untuk memanfaatkan pelayanan Puskesmas (AOR 1,213; 95% CI 1,196-1,230). Mereka yang berpendidikan SLTA memiliki kemungkinan 0,976 kali dibanding yang tidak sekolah untuk memanfaatkan pelayanan Puskesmas (AOR 0,976; 95% CI 0,955-0,997). Lebih lanjut, mereka yang berpendidikan PT memiliki kemungkinan 0,222 kali dibanding yang tidak sekolah untuk memanfaatkan pelayanan Puskesmas (AOR 0,222; 95% CI 0,211-0,233). Selain tingkat pendidikan, sembilan variabel kontrol juga ditemukan berkaitan dengan pemanfaatan Puskesmas di Pulau Madura. Kesimpulan: Berdasarkan hasil penelitian, dapat disimpulkan bahwa tingkat pendidikan berkaitan dengan pemanfaatan Puskesmas di Pulau Madura. Abstract Background: Madura is an area that is often left behind in the health sector in East Java, including health services utilization. Objective: The study aims to analyze the factors related to the Puskesmas utilization on Madura Island. Method: This cross-sectional study analyzed the 2018 Indonesia Basic Health Survey (Riskesdas) data. The study analyzed 7,239 respondents on Madura Island, East Java, as a sample using the stratification method and multistage random sampling. In addition to the Puskesmas utilization as an outcome variable and education level as an exposed variable, this study also analyzed nine control variables: district, residence, age, gender, marriage, occupation, socio-economics, insurance, and travel time. The study analyzed data using binary logistic regression. Result: The study found that those with elementary-junior high school education were 1.213 times more likely than those who did not go to school to take advantage of Puskesmas services (AOR 1.213; 95% CI 1.196-1.230). Those with high school education were 0.976 times more likely than those without school to use the Puskesmas services (AOR 0.976; 95% CI 0.955-0.997). Furthermore, those with higher education were 0.222 times more likely than those not in school to take advantage of Puskesmas services (AOR 0.222; 95% CI 0.211-0.233). Apart from education level, nine control variables were also found to be related to the utilization of Puskesmas on Madura Island. Conclusion: The study concluded the education level is related to the Puskesmas utilization on Madura Island.

Background The government must ensure equality in health services access, minimizing existing disparities between urban and rural areas. The referral system in Indonesia is conceptually sound. However, there are still problems of uneven service access, and there is an accumulation of patients in certain hospitals. The study aims to analyze the urban–rural disparities in hospital utilization in Indonesia. Methods The study used secondary data from the 2018 Indonesian Basic Health Survey. This cross-sectional study gathered 629,370 respondents through stratification and multistage random sampling. In addition to the kind of home and hospital utilization, the study looked at age, gender, marital status, education, occupation, wealth, and health insurance as control factors. The research employed multinomial logistic regression to evaluate the data in the final step. Results According to the findings, someone who lives in an urban region has 1.493 times higher odds of using outpatient hospital services than someone in a rural area (AOR 1.493; 95% CI 1.489–1.498). Meanwhile, someone who lives in an urban region has 1.075 times higher odds of using an inpatient facility hospital than someone who lives in a rural one (AOR 1.075; 95% CI 1.073–1.077). Furthermore, someone living in an urban region has 1.208 times higher odds than someone who lives in a rural area using outpatient and inpatient hospital services simultaneously (AOR 1.208; 95% CI 1.204–1.212). Conclusion The study concluded there were urban–rural disparities in hospital utilization in Indonesia.

The government encourages maternity care in health facilities to reduce maternal mortality. The study aims to analyze the impact of socioeconomic factors on healthcare facilities' choice for maternity care in Indonesia. The study used secondary data from the official report of the Indonesia Ministry of Health. The study takes all provinces as samples. Moreover, the study used the proportion of maternity care in health facilities as a dependent variable. On the other hand, the research analyzed four other variables as independent variables: percentage of the poor population, percentage of the population having health insurance, literacy percentage of population >15 years, and the unemployment rate for population >15 years. The study analyzed the data using a scatter plot. The study results show the lower the poor population in the province, the higher the proportion of maternity care in health facilities in that province. The higher the percentage of the population having health insurance in an area, the higher the proportion of maternity care in health facilities in that area. Meanwhile, the higher the literacy percentage of population >15 years in a province, the higher the proportion of maternity care in health facilities in that province. Moreover, the higher the unemployment rate for population >15 years in a province, the higher the proportion of maternity care in health facilities in that province. The study concluded that the four independent variables analyzed ecologically were associated with maternity care in health facilities.

Background: The study aims to analyze the relationship between socioeconomic and hospital utilization among female workers in Indonesia. Methods: The study analyzed secondary data from the 2018 Indonesian Basic Health Survey. The study gathered 161 186 female workers through stratification and multistage random sampling. As control factors, the study looked at age, marital status, education, occupation, and health insurance, in addition to the categories of socioeconomic and hospital utilization. The study used binary logistic regression to evaluate the data in the final step. Results: The result shows female workers with poorer wealth status are 1.142 times more likely than the most impoverished female workers to utilize the hospital (AOR 1.142; 95% CI 1.135-1.148). Female workers with median wealth status are 1.509 times more likely than the poorest female workers to take advantage of the hospital (AOR 1.509; 95% CI 1.501-1.517). Female workers with wealthier wealth status are 1.808 times more likely than the poorest female workers to use the hospital (AOR 1.808; 95% CI 1.799-1.817). The wealthiest female workers are 2.399 times more likely than the poorest female workers to utilize the hospital (2.399; 95% CI 2.387-2.411). Conclusion: The study concluded a relationship between socioeconomic status and hospital utilization among female workers in Indonesia. The better the socioeconomic, the better the hospital utilization.

Background: The study aims to analyze the relationship between socioeconomic and hospital utilization among female workers in Indonesia. Methods: The study analyzed secondary data from the 2018 Indonesian Basic Health Survey. The study gathered 161,186 female workers through stratification and multistage random sampling. As control factors, the study looked at age, marital status, education, occupation, and health insurance, in addition to the categories of socioeconomic and hospital utilization. The study used binary logistic regression to evaluate the data in the final step. Results: The result shows female workers with poorer wealth status are 1.142 times more likely than the most impoverished female workers to utilize the hospital (AOR 1.142; 95% CI 1.135-1.148). Female workers with median wealth status are 1.509 times more likely than the poorest female workers to take advantage of the hospital (AOR 1.509; 95% CI 1.501-1.517). Female workers with wealthier wealth status are 1.808 times more likely than the poorest female workers to use the hospital (AOR 1.808; 95% CI 1.799-1.817). The wealthiest female workers are 2.399 times more likely than the poorest female workers to utilize the hospital (2.399; 95% CI 2.387-2.411). Conclusion: The study concluded a relationship between socioeconomic status and hospital utilization among female workers in Indonesia. The better the socioeconomic, the better the hospital utilization.

BACKGROUND: The utilization of hospital services is a benchmark for the success of a health-care referral system. Indonesia as the largest archipelago in the world encounters challenging conditions along with lack of infrastructure posed economic and health disparity among its regions. Disparities as a result of this development also have an impact on the accessibility of health care facilities. Regions with good economic movements tend to have good accessibility to health-care facilities. For this reason, reducing disparity to achieve universal health services is the goal of health planners and policy-makers.

Abstrak Latar belakang: Kepulauan merupakan salah satu wilayah yang memerlukan perhatian dalam hal akses pelayanan kesehatan. Maluku merupakan salah satu provinsi di Indonesia yang memiliki 1.286 pulau. Penelitian ini bertujuan untuk menganalisis prediktor pemanfaatan Puskesmas di Provinsi Maluku, Indonesia. Metode: Studi menganalisis sampel besar sejumlah 788 responden yang dikumpulkan melalui survei online. Selain pemanfaatan Puskesmas, variabel yang dianalisis sebagai variabel bebas adalah umur, jenis kelamin, status perkawinan, tingkat pendidikan, jenis pekerjaan, agama, kepemilikan asuransi, waktu tempuh, dan biaya transportasi. Pada tahap akhir, penelitian melakukan uji multivariat menggunakan regresi logistik biner. Hasil: Hasil penelitian menunjukkan bahwa responden yang menikah 1,739 kali lebih mungkin menggunakan Puskesmas dibandingkan yang lajang (AOR 1,739; 95% CI 1,087-2,781). Responden yang berprofesi sebagai TNI/Polri berpeluang 0,247 kali lebih besar untuk menggunakan pelayanan Puskesmas dibandingkan yang tidak bekerja (AOR 0,247; CI 95% 0,062-0,989). Responden yang memiliki asuransi yang dikelola pemerintah memiliki kemungkinan 1,518 kali lebih besar untuk menggunakan Puskesmas dibandingkan mereka yang tidak diasuransikan (AOR 1,518; 95% CI 1,029-2,239). Hasil analisis menemukan waktu tempuh dan biaya transportasi bukan merupakan prediktor pemanfaatan Puskesmas untuk wilayah kepulauan di Provinsi Maluku, Indonesia. Kesimpulan: Hasil penelitian menyimpulkan tiga variabel yang terbukti menjadi prediktor pemanfaatan Puskesmas di Provinsi Maluku, Indonesia, yaitu status perkawinan, jenis pekerjaan, dan asuransi kesehatan. Kata kunci: Puskesmas, pelayanan kesehatan dasar, kepulauan, pemanfaatan pelayanan kesehatan, akses pelayanan kesehatan, kesehatan masyarakat. Pendahuluan Secara umum pengertian sehat adalah keadaan fisik, mental, dan sosial yang utuh. Kondisi ini bukan hanya tidak adanya penyakit atau kelemahan 1. Pemerintah membentuk sistem kesehatan untuk menyelenggarakan upaya kesehatan mulai dari preventif, promotif, kuratif, dan rehabilitatif untuk menjaga kesehatan masyarakat. Salah satu

Abstrak Latar belakang: Kepulauan merupakan salah satu wilayah yang memerlukan perhatian dalam hal akses pelayanan kesehatan. Maluku merupakan salah satu provinsi di Indonesia yang memiliki 1.286 pulau. Penelitian ini bertujuan untuk menganalisis prediktor pemanfaatan Puskesmas di Provinsi Maluku, Indonesia. Metode: Studi menganalisis sampel besar sejumlah 788 responden yang dikumpulkan melalui survei online. Selain pemanfaatan Puskesmas, variabel yang dianalisis sebagai variabel bebas adalah umur, jenis kelamin, status perkawinan, tingkat pendidikan, jenis pekerjaan, agama, kepemilikan asuransi, waktu tempuh, dan biaya transportasi. Pada tahap akhir, penelitian melakukan uji multivariat menggunakan regresi logistik biner. Hasil: Hasil penelitian menunjukkan bahwa responden yang menikah 1,739 kali lebih mungkin menggunakan Puskesmas dibandingkan yang lajang (AOR 1,739; 95% CI 1,087-2,781). Responden yang berprofesi sebagai TNI/Polri berpeluang 0,247 kali lebih besar untuk menggunakan pelayanan Puskesmas dibandingkan yang tidak bekerja (AOR 0,247; CI 95% 0,062-0,989). Responden yang memiliki asuransi yang dikelola pemerintah memiliki kemungkinan 1,518 kali lebih besar untuk menggunakan Puskesmas dibandingkan mereka yang tidak diasuransikan (AOR 1,518; 95% CI 1,029-2,239). Studi membuktikan waktu tempuh dan biaya transportasi bukan merupakan prediktor pemanfaatan Puskesmas di wilayah kepulauan di Provinsi Maluku, Indonesia. Kesimpulan: Hasil penelitian menyimpulkan tiga variabel yang terbukti menjadi prediktor pemanfaatan Puskesmas di Provinsi Maluku, Indonesia, yaitu status perkawinan, jenis pekerjaan, dan asuransi kesehatan. Kata kunci: Puskesmas, pelayanan kesehatan dasar, kepulauan, pemanfaatan pelayanan kesehatan, akses pelayanan kesehatan, kesehatan masyarakat.

The government's task is to ensure easy access for the public to the health facilities needed. The study aimed at analyzing ecologically the factors related to the accessibility of hospitals in Indonesia. The ecological analysis conducted using secondary data from the Ministry of Health of the Republic of Indonesia report in 2018. The study takes all provinces as samples. Apart from households easily accessible to the hospital, five other variables analyzed as independent variables were total population, population density, poverty depth index, poverty severity, and population percentage completing primary education. Data were analyzed using a scatter plot. The study results found that the higher the total population in a province, the higher the percentage of households easily accessible to the hospital in that province. The higher the population density in an area, the higher the percentage of households access to the hospital in that area. On the other hand, the higher the poverty depth index in a region, the lower the percentage of households easily accessible to the hospital in that province. Moreover, the higher the poverty severity index in a region, the lower the percentage of households easily accessible to the hospital in that region. Finally, the higher the percentage of the population completing primary education in a province, the higher the percentage of households easily accessible to the hospital in that province. It concluded that five independent variables were analyzed related to the accessibility of hospitals in Indonesia.

The border area is one area that needs government attention. The study was aimed at analyzing disparities in hospital use in Kalimantan based on the border-non-border area category. The study was conducted using data from the 2013 Indonesian Basic Health Survey. With the multi-stage cluster random sampling method, 69,043 respondents were obtained. In the final stage, a Multinomial Logistic Regression test was performed to determine any disparities. The study results found that the utilization of inpatient at the hospital for those living in the border area has a probability of utilization of 0.653 times compared to those who live in non-border areas. Those who live in the border have a lower chance than those who live in non-border areas of using inpatient hospital. The results of the study also found 8 other predictors that influence hospital utilization among adults in Kalimantan Island, Indonesia. The eight predictors are the type of place of residence, marital, education, work type, socioeconomic, health insurance, travel time, and transportation cost. It could be concluded that there was a disparity in hospital utilization in the border-non-border areas in Kalimantan Island, Indonesia. Those living in border areas have a lower likelihood of inpatient utilization than those living in non-border areas.

Oral and dental health is an integral part of general health which requires attention. This study was conducted to analyze the ecological factors associated with the proportion of dental and oral utilization in Indonesia. The ecological analysis was conducted using secondary data from the Ministry of Health of the Republic of Indonesia report in 2018. All provinces were taken as samples. Apart from the proportion of dental and oral utilization, 5 other variables analyzed as independent variables were a percentage of 9-year gross enrollment rate, percentage of poor people, the proportion of damaged/cavity/sore teeth, proportion of missing teeth due to extraction/date itself, and ratio of PHC per district. The results show that 4 variables tend to have a positive relationship with the proportion of dental and oral utilization. The four variables are the percentage of 9-year gross enrollment rate, the proportion of damaged/cavity/sore teeth, proportion of missing teeth due to extraction/date itself, and the ratio of PHC per district. On the other side, 1 variable was found to tend to have a negative relationship with the proportion of dental and oral utilization, namely the percentage of poor people. It could be concluded that the five independent variables analyzed tend to have a relationship with the proportion of dental and oral utilization in Indonesia.

The border area is one area that needs government attention. The study was aimed at analyzing disparities in hospital use in Kalimantan based on the border-non-border area category. The study was conducted using data from the 2013 Indonesian Basic Health Survey. With the multi-stage cluster random sampling method, 69,043 respondents were obtained. In the final stage, a Multinomial Logistic Regression test was performed to determine any disparities. The study results found that the utilization of inpatient at the hospital for those living in the border area has a probability of utilization of 0.653 times compared to those who live in non-border areas. Those who live in the border have a lower chance than those who live in non-border areas of using inpatient hospital. The results of the study also found 8 other predictors that influence hospital utilization among adults in Kalimantan Island, Indonesia. The eight predictors are the type of place of residence, marital, education, work type, socioeconomic, health insurance, travel time, and transportation cost. It could be concluded that there was a disparity in hospital utilization in the border-non-border areas in Kalimantan Island, Indonesia. Those living in border areas have a lower likelihood of inpatient utilization than those living in non-border areas.

Living in urban areas brings its consequences for pregnant women, especially for those who are poor. The purpose of the study was to analyse socioeconomic disparities in ANCs in urban Indonesia. The samples used were women aged 15-49 years old who had given birth in the last 5 years in urban Indonesia. The sample size was 7,568 women. The variables analysed included antenatal care (ANC), socioeconomic, age, have a husband/partner, education, parity, and health insurance. The disparity was determined by binary logistic regression. Women in a socioeconomic poorer category were 1.306 times more likely than the poorest to make complete ANC visits. Women who have a socioeconomic middle category are 1.758 times more likely compared to the poorest to make complete ANC visits. Women who have socioeconomic richer categories were 2.618 times more likely than the poorest to make complete ANC visits. The richest women were 1.306 times as likely as the poorest women to make complete ANC visits. This information shows that the better the socioeconomic status of a woman in urban areas of Indonesia, the more likely it was to make a complete ANC visit. Other variables also found as predictors of ANC visits were age, have a husband/partner, education, parity, and health insurance. There was a significant disparity between socioeconomic groups in ANC utilisation in urban Indonesia. The better the socioeconomic status of a woman, the more likely she was to make a complete ANC visit.

Background: Living in urban areas brings its consequences for pregnant women, especially for those who are poor. The purpose of the study was to analyze socioeconomic disparities in ANCs in urban Indonesia. Methods: The samples used were women aged 15-49 years old who had given birth in the last 5 years in urban Indonesia. The sample size was 7,568 women. The variables analyzed included antenatal care (ANC), socioeconomic, age, have a husband/partner, education, parity, and health insurance. The disparity was determined by binary logistic regression. Results: Women who have a socioeconomic poorer category were 1.306 times more likely than the poorest to make complete ANC visits. Women who have a socioeconomic middle category have 1.758 times compared to the poorest to make complete ANC visits. Women who have socioeconomic richer categories were 2.618 times more likely than the poorest to make complete ANC visits. The richest women were 1.306 times as likely as the poorest women to make complete ANC visits. This information shows that the better the socioeconomic of a woman in urban areas of Indonesia, the more likely it was to make a complete ANC visit. Other variables also found as predictors of ANC visits were age, have a husband/partner, education, parity, and health insurance. Conclusion: There was a significant disparity between socioeconomic in ANC utilization in urban Indonesia. The better the socioeconomic of a woman, the more likely it was to make a complete ANC visit.

The purpose of this research to analyse the determinants of hospital utilisation in urban poor societies in Indonesia. The data was part of the 2013 Basic Health Research (Riskesdas). The analysis involved 57,296 urban poor societies in Indonesia. Estimates used the binary logistic regression test. The result shows that age and marital status have an effect on hospital utilisation-those who worked having 1.512 times the likelihood of having utilised the hospital than those who did not work: while those who have insurance were 0.513 times more likely than those who were uninsured. Those who have a travel time of ≤15 minutes have 0.686 times the likelihood than those who have a travel time of >15 minutes. While those who require transportation costs IDR 10,000 to the hospital have a likelihood of 0.692 times more than those with transportation costs >IDR 10,000 in utilising the hospital. There were 6 determinants of Hospital Utilisation at Urban Poor Societies in Indonesia.

ABSTRAK Kebijakan mendorong persalinan di fasilitas pelayanan kesehatan ditekankan untuk menurunkan angka kematian ibu yang masih tinggi di Indonesia. Studi ditujukan untuk menganalisis variabel kependudukan, sosial-ekonomi dan input sumber daya yang berhubungan dengan persalinan di fasilitas pelayanan kesehatan. Desain studi menggunakan pendekatan studi ekologi (studi agregat) bersumber data Profil Kesehatan Indonesia Tahun 2018. Analisis bivariat dilakukan dengan menggunakan scatter plot dan uji korelasi Pearson. Hasil penelitian menunjukkan disparitas persentase cakupan persalinan ke fasilitas pelayanan kesehatan yang sangat lebar, Provinsi Maluku memiliki cakupan paling rendah (45,18%), sementara cakupan tertinggi dicapai Provinsi DKI Jakarta (100%). Hasil scatter plot dan uji bivariat menunjukkan bahwa semakin banyak jumlah penduduk pada suatu provinsi maka ada kecenderungan cakupan persalinan di fasilitas pelayanan kesehatan menjadi semakin tinggi. Semakin dalam dan parah kemiskinan pada suatu provinsi maka ada kecenderungan cakupan persalinan di fasilitas pelayanan kesehatan menjadi semakin rendah. Semakin banyak dokter spesialis obgyn dan rumah sakit pada suatu provinsi maka ada kecenderungan cakupan persalinan di fasilitas pelayanan kesehatan menjadi semakin tinggi. Disimpulkan bahwa jumlah penduduk, rasio dokter spesialis obgyn dan rasio rumah sakit (RS) memiliki hubungan positif, sementara Indeks Kedalaman dan Keparahan Kemiskinan memiliki kecenderungan hubungan negatif dengan cakupan persalinan di fasilitas pelayanan kesehatan. Disarankan pemerintah menyusun kebijakan khusus pada sasaran wilayah dengan jumlah penduduk sedikit, miskin dan memiliki dokter spesialis obgyn dan RS yang sedikit. Kata kunci: persalinan di fasilitas pelayanan kesehatan, kebijakan persalinan, pelayanan kesehatan ABSTRACT Policies to encourage childbirth in health care facilities were emphasized to reduce maternal mortality rates that are still high in Indonesia. The study was aimed at analyzing population, socioeconomic , and resource input variables related to childbirth in health care facilities. This study used an ecological study approach (an aggregate study) sourced from the 2018 Indonesia Health Profile. Bivariate analysis was performed using scatter plots and Pearson correlation tests. The results showed a wide disparity in terms of childbirth in health care facilities coverage. Maluku was the province with the lowest coverage (45.18%), while the highest coverage was achieved by DKI Jakarta (100%). The results of scatter plots and bivariate tests showed that the more population in a province, the higher the coverage of delivery in health care facilities, the deeper and worse the poverty in a province, the lower the coverage of delivery in health care facilities. The more obstetrician and hospitals in a province, there was a tendency for coverage of births in health care facilities to be higher. In conclusion, population, the ratio of obstetricians, and the ratio of hospitals have a positive relationship with deliveries in healthcare facilities. In contrast, the Poverty Depth and Severity Index has a tendency to had a negative relationship with the coverage of deliveries in health care facilities. It was recommended that the government formulate specific policies to target regions with a small population, poor and have a small number of obstetricians and hospitals.

Hospitals were advanced referral health facilities or referrals for basic health services, it was very important for policymakers to know the factors that it was able to predict hospital use. The research objective was to determine the predictors of hospital use among Papuans in Indonesia. Data source from raw data of the 2013 Indonesia Basic Health Survey. Indonesia Basic Health Survey was a cross-sectional survey. The multi-stage cluster random sampling method was used to get 30,620 Papuan respondents. Multinomial Logistic Regression Test is used to determine the predictors of hospital utilization. There were 8 predictors of hospital utilization in outpatients used consisting of age, urban-rural area, gender, education level, socioeconomic status, insurance ownership, travel time and transportation costs, there were 5 predictor variables in hospital utilization in patients hospitalization consisting of gender, type of work, socioeconomic status, travel time and transportation costs, and there were 2 predictors in hospital utilization in outpatient and inpatient care at the same time consisting of the cost of time travel and transportation to the hospital. Overall there were 9 predictor variables of hospital utilization in all categories (outpatient and inpatient).

Aim The purpose of this study was to analyse the barriers to healthcare utilization for delivery in rural Indonesia. Subjects and Methods The included subjects were women aged 15-49 years who had given birth in the last 5 years in rural Indonesia. The sample size was 9,046 women. The variables analysed included the utilization of healthcare facilities, age, education, work, marital status, parity, wealth, health insurance, autonomy of family finances, autonomy of health, knowledge of pregnancy, and antenatal care (ANC). The barriers were determined by binary logistic regression. Results Women with higher education were 2.288 times more likely to utilize healthcare facilities for delivery than women with no education. Multiparous women were 1.582 times more likely to use healthcare facilities for delivery than grand multiparous women. The richest women were 4.732 times more likely to use healthcare facilities for delivery than the poorest women. Women who were covered by health insurance were 1.363 times more likely to utilize healthcare facilities for delivery than women who did not have insurance. Women who knew the danger signs of pregnancy were 1.497 times more likely to use healthcare facilities for delivery than women who did not know the danger signs. Women who underwent ANC ≥4 times were 1.976 times more likely to use healthcare facilities for delivery than women who underwent ANC <4 times. Conclusion There were 6 factors that were identified as barriers to the utilization of healthcare facilities for delivery in rural Indonesia. These six factors were low education, high parity, poverty, not having health insurance, not knowing the danger signs of pregnancy, and ANC <4 times.

The pattern of diseases in the elderly people usually is degenerative diseases which often catastrophic and high cost. Unfortunately, a large financial intervention is often having the wrong target, precisely because of the more utilized by high socio-economic groups. This article is devoted to an analysis of hospital utilization disparity based on the socioeconomic status on the elderly in Indonesia. The data processed from the 2013 Indonesian Basic Health Survey (Riskesdas) with a sample size of 199,653 elderlies. Estimation by using multinomial logistic regression test used to explore the disparity between socioeconomic characteristics of the elderly in hospital utilization. Quintile 1 likelihood 0.355 times utilizing hospital outpatient than quintile 5 (OR 95% CI; 0.355 0.302-0.418). Quintile 1 likelihood 0.414 times utilizing hospital inpatient than quintile 5 (OR 95% CI; 0.414 0.366-0.468). Quintile 1 likelihood 0.247 times utilizing outpatient inpatient at once than quintile 5 (OR 95% CI; 0.247 0.184-0.332). The better the socioeconomic status is getting better the hospital utilization of the elderly.

Madurese communities often have a low public health status. These could be seen from the health development achievements four regencieson the island. This research was intended to analyze the determinant ofthe Puskesmas utilization in Madura Island. The Data derived from the 2013 Riskesdas. The analysis usingbinary logistic regression to examine the determinant of the Puskesmas utilization. The results of the study showed the Madurese in Bangkalan likelihood 2,120 times more utilize the Puskesmas than in Sumenep (OR 2.120; 95% CI 1.448–3.105). Madurese in Pamekasan 1.410 times more likely to utilize the Puskesmas than in Sumenep (OR 1.410; 95% CI 1.025–1.940). Age affects the Puskesmas utilization, while rurality did not show a significant influence. Those who pass the primary school were likelihood 0.225 times to utilize of Puskesmas than the graduates of the college (OR 0.225; 95% CI 0.054–0.946). The Madurese in quintile 4 seen has no difference from those in quintile 5. While the Madurese who insured likelihood 0.650 times to utilize the Puskesmas than who not insured (OR 0.650; 95% CI 0.517–0.818). The Madurese that has a shorter time to the Puskesmas likelihood 0.616 times more utilize than that have a long time (OR 0.616; 95% CI 0.479–0.791). The research concluded that from 9 factors related to the Puskesmas utilization in Madura Island, there are 7 factors that are determinants, namely the regency, age, education, work status, socioeconomic, insurance, and travel time.

In Indonesia, only 74% of women give birth in health care facilities. This study was conducted to analyze the socioeconomic disparities of facilities-based childbirth in Indonesia. The analysis in this study uses raw data from the 2017 Indonesia Demographic and Health Survey (IDHS). With stratification and multistage random sampling, 17,769 women aged 15-49 years with live births in the last 5 years were sampled. Data were analyzed using a Binary Logistic Regression test. Poorer women were 1.898 times more likely to use healthcare facilities for delivery than poorest women. Middle women were 2.669 times more likely to use healthcare facilities for delivery than poorest women. Richer women have 3.163 times more opportunities to use healthcare facilities for delivery than poorest women. The richest women were 6.566 times more likely to use healthcare facilities for delivery than the poorest women. Women who live in urban areas were 2.412 times more likely to use healthcare facilities for delivery than those who live in rural areas. Age, parity, level of education, ownership of health insurance, knowledge of the danger signs of pregnancy, and antenatal care, in maternity women the past five years significantly contribute to the utilization of healthcare facilities for delivery. There was a significant disparity between socioeconomic in utilizing healthcare facilities for delivery in Indonesia. Women with better socioeconomic status have better possibilities for utilizing healthcare facilities for delivery.

Introduction. The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in >=4 ANC visits during pregnancy in Indonesia. Methods. Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15–49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. Results. With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making >=4 ANC visits compared to those in the Papua region (95% CI 3.229–5.899). Women in Java-Bali have 3.607 times the chance of making >=4 ANC visits compared to women in the Papua region (95% CI 2.741–4.746). Women in Sumatra have 1.370 times the chance of making >=4 ANC visits compared to women in the Papua region (95% CI 1.066–1.761). Women in Kalimantan have 2.232 times the chance of making >=4 ANC visits compared to women in the Papua region (1.664–2.994). Women in Sulawesi have 1.980 times more chance of making >=4 ANC visits compared to women in the Papua region (1.523–2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. Conclusion. There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of >=4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.

The successful implementation of efforts to improve the quality of health services is influenced by many variables, both organizational and individual variables. The two main variables that are widely discussed when studying the level of organizational readiness to change are commitment to change and efficacy to change. This research was conducted to analyze change commitment and change the efficacy of Public Health Centers (PHC) in Indonesia in implementing efforts to improve the quality of health services. A cross-sectional survey was conducted on health workers in 40 PHCs in Surabaya, to measure change commitment, change efficacy, and efforts to improve the quality of health services that have been implemented. The rank Spearman correlation test is done to prove the relationship between these variables. The results showed that the implementation of efforts to improve the quality of health services was not significantly related to change commitment, but there was a significant relationship with change efficacy. Therefore, so that the implementation of efforts to improve the quality of health services can run well, it is necessary to carry out various activities to improve the capabilities and skills of the staff of PHCs to have an impact on increasing efficacy.

Access to health services is often seen only from the provider perspective, while from the community side as a user is less noticed. Improving the quality of health services access requires a complete perspective on two different sides. This research is designed descriptively qualitative. Data were collected by Focus Group Discussion (FGD), in-depth interview and observation. The research was conducted in Malang Regency in June-August 2018. The study results showed health services access generally the community believes that there are still perceived defi ciencies. Especially on the aspect of physical access, due to poor facilities and infrastructure. In addition, social access was also considered inadequate, because there were still health workers who served with less friendly. This study concludes that people still feel access to physical and social aspects is still difficult. It should be recommended to the local government for efforts to improve physical access, and the Health Office to disseminate health information about the rights of patients to the community.

ABSTRAK Sejak diberlakukannya kebijakan Jaminan Kesehatan Nasional (JKN), seluruh puskesmas di Indonesia wajib mengikuti akreditasi. Melalui akreditasi, diharapkan kualitas pelayanan puskesmas semakin meningkat, salah satu diantaranya dapat dilihat dari peningkatan kepuasan pasien. Penelitian ini dilakukan untuk menganalisis pengaruh akreditasi terhadap kepuasan pasien. Penelitian ini merupakan penelitian observasional dengan rancang bangun cross-sectional, yang dilakukan kepada 90 pasien puskesmas yang pernah berkunjung ke puskesmas sebelum dan sesudah akreditasi. Sampel diambil secara accidental sampai memenuhi kuota yang ditetapkan untuk tiap puskesmas. Uji Paired-Sample T Test dilakukan untuk melihat signifikansi perbedaan skor kepuasan sebelum dengan sesudah akreditasi. Hasil penelitian menunjukkan terdapat perbedaan skor kepuasan yang signifkan antara sebelum dengan sesudah akreditasi untuk dimensi mutu responsiveness, credibility, competence, communication, security, access, courtesy, understanding customer dan tangibles. Dimensi reliability tidak ditemukan perbedaan yang signifikan. Sedangkan khusus untuk dimensi understanding cutomer terjadi penurunan skor kepuasan sesudah akreditasi. Dengan demikian dapat disimpulkan bahwa akreditasi berpengaruh terhadap kepuasan pasien. Oleh karena itu, penting bagi puskesmas memperbaiki sistem pelayanannya terutama terkait dengan pemenuhan janji layanan yang telah ditetapkan sebagai sasaran mutu. Penyebaran informasi kepada masyarakat harus ditingkatkan, agar masyarakat menjadi mengetahui adanya akreditasi yang dijalankan oleh puskesmas. Kata kunci : Akreditasi, kepuasan, mutu, pasien, puskesmas ABSTRACT Since the enactment of the National Health Insurance (JKN) policy, all Primary Health Care in Indonesia must follow accreditation. Through accreditation, it is expected that the quality of Primary Health Care services will increase, one of which can be seen from the increase in patient satisfaction. This study was conducted to analyze the effect of accreditation on patient satisfaction. The study was conducted on 90 Primary Health Care patients who had visited the Primary Health Care before and after accreditation. Data retrieval has been done crossectionally. The paired-sample T test was conducted to see the significance of differences in satisfaction scores before and after accreditation. The results showed that there were significant differences in satisfaction scores between before and after accreditation for the dimensions of responsiveness, credibility, competence, communication, security, access, courtesy, understanding customer and tangibles. In the reliability dimension no significant differences were found. While specifically for the cutomer understanding dimension there was a decrease in satisfaction scores after accreditation. Therefore, it is important for Primary Health Care to improve their service systems, especially related to fulfilling service promises that have been set as quality objectives. Dissemination of information to the public must be improved, so that the public becomes aware of the existence of programs run by the Primary Health Care, such as accreditation.

Background: Urban always attracts investors to invest. Health facilities in urban areas are growing rapidly compared to villages. This condition is estimated to contribute to the disparity of urban-rural areas in the utilization of health services. Studying the utilization of health services is a way to evaluate the performance of the health care system through its output. Aim: This study analyzed the urban-rural disparity in the utilization of primary healthcare center by the elderly. Method: This study used in the 2013 Basic Health Research raw data. The 2013 Basic Health Research was designed as a cross-sectional survey. With the multi-stage cluster random sampling method, 25,813 elderly people in East Java Province participated. Data were analyzed using Multinomial Logistic Regression tests. Results: Elderly people in urban areas have a better probability of outpatient use of 1.208 than those living in rural areas (OR 1.208; 95% CI 1.057-1.380). The elderly who have a primary school and under education have the possibility of 1.558 times more utilizing outpatients in primary healthcare centers than the elderly who have college education levels (OR 1.558; 95% CI 1.001-2.424). Conclusion: There was a disparity between urban and rural areas in the utilization of outpatient primary healthcare centers in East Java by the elderly. Policymakers in East Java are recommended to improve facilities and infrastructure of the primary healthcare centers in rural areas by paying attention to the results of this study. Keywords: elderly, urban-rural disparities, primary healthcare center, healthcare utilization, inpatient-outpatient.

Background and Objective: Indonesia is a developing country with the third highest prevalence of stunting in the South East Asian region. The present study analyzed characteristics of mothers as predictors of stunting in children under 5 years-old in Indonesia. Materials and Methods: Data from the 2017 Indonesian Nutritional Status Monitoring Survey was used. Using multi-stage cluster random sampling, 149,571 toddlers aged 0-59 months and their mothers were examined. Stunting as an indicator of nutritional status was assessed based on height per age. Characteristics of mothers included age, marital status, education level, work status, and residence. Data were analyzed using multinomial logistic regression. Results: Age of mothers was a significant predictor of stunting risk in toddlers. Toddlers with married mothers had 0.862-and 0.771-times higher risk of stunting and severe stunting, respectively, compared to toddlers of divorced mothers. Toddlers of mothers with only a primary school education had 2.248-times higher risk of severe stunting compared to toddlers of college-educated mothers. Toddlers of nonworking mothers had 0.951-times higher risk of severe stunting compared to toddlers of working mothers. Conclusion: Age, marital status, education level, work status, and residence of mothers were predictors of stunting of toddlers in Indonesia.

Objective: The purpose of this study was to analyze the barriers to healthcare utilization for delivery in rural Indonesia. Methods: The samples used were women aged 15-49 years old who had given birth in the last 5 years in rural Indonesia. The sample size was 9,046 women. The variables analyzed included the utilization of healthcare facilities, age, education, work, marital, parity, wealth, health insurance, the autonomy of family finances, the autonomy of health, knowledge of pregnancy, and antenatal care (ANC). Determination of the barrier was determined by the binary logistic regression. Results: Women with higher education were 2.288 times more likely to utilize healthcare facilities for delivery compared to no education women. Multiparous women were 1.582 times more likely to use than grande multiparous women. The richest women were 4.732 times more likely to use than the poorest. Women who were covered by health insurance have the possibility of 1.363 times more utilize than women who do not have insurance. Women who know the danger signs of pregnancy 1.497 times more likely to use than women who don't know. Women who do ANC ≥4 times have the possibility of 1.976 times more use than women who do ANC <4 times. Conclusion: There were 6 factors that become barriers to the utilization of healthcare facilities for delivery in rural Indonesia. These six factors were low education, high parity, poverty, not having health insurance, not knowing the danger signs of pregnancy, and ANC <4 times.

Objective: The study was aimed at analyzing regional disparities of childbirth services in Indonesia. Methods: The analysis in this study uses raw data from the 2017 Indonesian Demographic Health Survey (IDHS). Stratification and multistage random sampling were used in the 2017 IDHS. The sample used in this study was 17,769 women aged 15-49 years with live births in the last 5 years. Data were analyzed using Binary Logistic Regression test. Results: There was a significant disparity between all regions compared to the Papua region, except for the Kalimantan and Sulawesi regions. Sumatra Region has 1.475 times more possibility to utilize healthcare facilities for delivery than Papua region (OR 1.475; 95% CI 1.198-1.815). The Java-Bali region has 3.010 times more possibility to utilize healthcare facilities for delivery compared to the Papua region (OR 3.010; 95% CI 2.410-3.759). The Nusa Tenggara region has 1.891 times more opportunities to use healthcare facilities for delivery than the Papua region (OR 1.891; 95% CI 1.508-2.372). While the Maluku region has lower utilization than the Papua region. Maluku Region has the possibility of 0.304 times utilizing healthcare facilities for delivery compared to the Papua region (OR 0.304; 95% CI 0.240-0.358). Conclusion: Based on the results of the study it can be concluded that there were significant disparities between regions in utilizing healthcare facilities for delivery in Indonesia.

Policies to encourage childbirth in health care facilities were emphasized to reduce maternal mortality rates that are still high in Indonesia. The study was aimed at analyzing population, socio-economic and resource input variables related to childbirth in health care facilities. The study design uses an ecological study approach (an aggregate study) sourced from the 2018 Indonesia Health Profile. Bivariate analysis was performed using scatter plots and Pearson correlation tests. The results showed a disparity in the percentage of childbirth coverage to health care facilities that was very wide, Maluku Province had the lowest coverage (45.18%), while the highest coverage was achieved by DKI Jakarta Province (100%). The results of scatter plots and bivariate tests show that the more population in a province, the higher the coverage of delivery in health care facilities. The deeper and worse the poverty in a province, the lower the coverage of delivery in health care facilities. The more obgyn specialists and hospitals in a province there was a tendency for coverage of births in health care facilities to be higher. It could be concluded that the population, the ratio of obstetricians and the ratio of hospitals have a positive relationship, while the Poverty Depth and Severity Index has a tendency to have a negative relationship with the coverage of deliveries in health care facilities. It was recommended that the government formulate specific policies to target regions with a small population, poor and have a small number of obstetricians and hospitals.

To give priority or free expense medication of basic health service in Puskesmas to Banyuwangi society and to depress of health reference service at hospital and also blaze the way manage care system in Banyuwangi Regency, Government of Banyuwangi regency release JPKMB policy that is free expense of basic health service in puskesmas and puskesmas's network. This research was aimed to studying customer satisfaction in service, accessibility and equity of Puskesmas as health service provider of JPKMB. This was a descriptive research done from June to August 2007 conducted by interview to Puskesmas customers as participant of JPKMB in Puskesmas Purwoharjo of Banyuwangi regency. The research sample was taken by simple random sampling technique. Base on confidence level at 95%, anticipate population proportion at 0,5, absolute precision required at 0,01 , and maximum population at 25.000, minimum sample that must be taken counted 96 respondent, in this research taken respondent counted 112 respondent. The conclusion was indicated that patient sattsfaction level in Puskesmas Purwoharjo very high in the case of perceived service. The satisfaction level of puskesmas accessibility and equity was high enough, exceeding satisfaction level which is expected in JPKMB equal to 70%. With high level satisfaction of JPKMB participant expected by the make-up of JPKMB package benefit become contmualton health service up to plenary health service. PENDAHULUAN Diberlakukannya Undang-undang (UU) No. 22 dan No. 25/1999 tentang Pemerintahan Dae rah membuat wacana baru tentang otonom i daerah menjadi kenyataan. Kebijakan ya ng kemudian disempumakan dengan UU No. 32/2004 tersebut pada akhirnya membawa perubahan kepada semua bidang pembangunan tidak terkecuali bidang kesehatan. Menurut Mard iasmo (2002) perubahan pada bidang kesehatan secara garis besar terdiri dari dua hal, yaitu; 1) perubahan dalam sistem dan proses organisasional , 2) Keadilan , efisiensi dan kualitas pelayanan. Perubahan dala m sistem dan proses organisasional terdiri dari pembangunan kebijakan kesehatan , kebutuhan penghitungan dan informasi, perencanaan dan alokasi sumber daya, pembiayaan dan manajemen keu angan , perencanaan dan manaj emen sumber daya man usia, koordinasi antarsektoral dan partisipasi masyarakat. • Dinas Kesehatan Kabupaten Banyuwangi Realitas te rsebut menunjukkan besarnya perubahan mendasar di bidang kesehatan yang terjadi dalam era desentralisasi, hampir semuanya tergantung pada daerah. Oleh karena itu , diperlukan kemampuan din as kesehatan agar dapat menetapkan prioritas program kesehatan , serta memiliki kemampuan advokasi kepada pemerintah daerah dan lembaga legislatif dalam upaya mendapatkan political commitment peningkatan alokasi anggaran. Diperlukan juga kemampuan tenaga kesehatan untuk melakukan perencanaan program dan anggaran , implementasi, dan evaluasi program (Bud iarto , 2003). Memahami permasalahan tersebut, Pemenntah Ka bu paten Banyuwangi mengeluarkan kebijakan pembiayaan kesehatan berupa Jaminan Pelayanan Kesehatan Masyarakat Bany uwan gi (JPK MB) yaitu bebas biaya pelayanan kesehatan dasar di puskesmas dan jaringannya. Maksudnya adalah mengalihkan beban biaya yang selama ini ditanggung

Background: Although hospital services were available, urban poor people often have limited access to hospitals when needed. This study was conducted to analyze the determinants of childbirth in a hospital in urban poor women in Indonesia. Methods: The analysis in this study uses raw data from the 2017 IDHS. With stratification and multistage random sampling, 7891 women aged 15-49 years in urban poor communities with live births in the last 5 years were sampled. Data were analyzed using a Binary Logistic Regression test. Results: The results of the study found that "problems during pregnancy" was not proven as a determinant of the hospital use for delivery in urban poor women in Indonesia. Age was proven to be one of the determinants, while in the education level category, urban poor women with tertiary education were 2.506 times more likely to use hospitals for delivery than urban poor women who were not in school. Parity was significantly proven as one of the determinants that influence the use of hospital for delivery in urban poor women in Indonesia. Urban poor women who were covered by health insurance have 1.933 times more possibility of utilizing hospital for delivery than those who do not have health insurance. It could be concluded that "problem during pregnancy" variable was not a predictor of the hospital use for childbirth in the urban poor community in Indonesia. Conslusions. The determinants or variables that influence, on the hospital use for childbirth were age, education level, parity, and ownership of health insurance.

Background: In Indonesia, only 74% of women give birth in health care facilities. This study was conducted to analyze the socioeconomic disparities of facilities-based childbirth in Indonesia.Methods: The analysis in this study uses raw data from the 2017 Indonesia Demographic and Health Survey (IDHS). With stratification and multistage random sampling, 17,769 women aged 15-49 years with live births in the last 5 years were sampled. Data were analyzed using a Binary Logistic Regression test.Results: Poorer women were 1.898 times more likely to use healthcare facilities for delivery than poorest women. Middle women were 2.669 times more likely to use healthcare facilities for delivery than poorest women. Richer women have 3.163 times more opportunities to use healthcare facilities for delivery than poorest women. The richest women were 6.566 times more likely to use healthcare facilities for delivery than the poorest women. Women who live in urban areas were 2.412 times more likely to use healthcare facilities for delivery than those who live in rural areas. Age, parity, level of education, ownership of health insurance, knowledge of the danger signs of pregnancy, and antenatal care, in maternity women the past five years significantly contribute to the utilization of healthcare facilities for delivery.Conclusion: There was a significant disparity between socioeconomic in utilizing healthcare facilities for delivery in Indonesia. Women with better socioeconomic status have better possibilities for utilizing healthcare facilities for delivery.

Background: Equitable distribution of health services between areas is still a problem in various countries. Even in developed countries. This condition also applies to the utilization of healthcare facilities for childbirth. Objective: To analyze the urban-rural disparities of facilities-based childbirth in Indonesia. Methods: The analysis in this study uses raw data from the 2017 IDHS. With stratification and multistage random sampling, 17,769 women aged 15-49 years with live births in the last 5 years were sampled. Data were analyzed using a Binary Logistic Regression test. Results: Women in urban areas were probably 2.417 times more utilizing healthcare facilities for delivery than those in rural areas. Women with tertiary education were likely to be 1.709 times more utilizing healthcare facilities for delivery than those who don't. Richest women were probably 6.556 times more utilizing healthcare facilities for delivery than poorest women. Women who have health insurance maybe 1.437 times more utilizing healthcare for delivery than women who don't have. Women who know about the danger signs of pregnancy are more than 1.514 times more likely to utilize healthcare for delivery than those who don't know. Women who do ANC ≥ 4 times have the possibility of 1.729 times using healthcare facilities compared to those who do ANC less than 4. Conclusion: There were significant differences between women in urban and rural areas in utilizing healthcare facilities for delivery. Women who live in urban areas have a better chance to utilize healthcare facilities for delivery. The government needs to focus on women with low education and poor status. Interventions were needed by socializing the danger signs of pregnancy in rural areas. In addition, it was also necessary to expand the scope of membership of the National Health Insurance in rural areas.

Introduction: Urban always attracts investors to invest. Health facilities in urban areas are growing rapidly compared to villages. This condition is estimated to contribute to the disparity of urban-rural areas in the utilization of health services. Studying the utilization of health services is a way to evaluate the performance of the health care system through its output. Aim: This study was intended to analyze urban-rural disparity in the utilization of primary health care or puskesmas use by the elderly.Methods: This study was used the 2013 Riskesdas (Indonesian Basic Health Survey) raw data. The 2013 Riskesdas was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 25,813 elderly people in East Java Province were obtained. Data were analyzed using Multinomial Logistic Regression tests.Results: Elderly people in urban areas have a better probability of outpatient use of 1.208 than those living in rural areas (OR 1.208; 95% CI 1.057-1.380). The elderly who have a primary school and under education have the possibility of 1.558 times more utilizing outpatients in the puskesmas than the elderly who have college education levels (OR 1.558; 95% CI 1.001-2.424). Conclusions: There was a disparity between urban and rural areas in the utilization of outpatient puskesmas in East Java by the elderly. Policy makers in East Java are recommended to improve facilities and infrastructure of the puskesmas in rural areas by paying attention to the results of this study.

Introduction: The distribution of health workers was an important study in Indonesia which has a wide geographical range and challenges as an archipelagic country for the fulfillment of fair and equitable health services. Aim: The study was conducted to answer factors related to the distribution of doctors based on provinces in Indonesia. Methods: Advanced analysis of secondary data from "Data and Information: Indonesian Health Profile in 2017". The analysis unit in this study was the province, all 34 provinces in Indonesia were analyzed. The dependent variable was the Number of Doctors. Dependent variables were the number of population, density, percentage of poor people, number of hospitals, and number of the Community Health Center. Results: Variability in the availability of doctors was very wide. The more the population, the more attractive it was for doctors to practice in the province. The denser the population, the more attractive it was for doctors to practice. The more hospitals, the more attractive it was for doctors to practice in the province. The more Community Health Center, the more attractive it was for doctors to practice in the province. Conclusions: Based on the results of the study, it can be concluded that from the five independent variables studied, there were four variables related to the number of doctors. Variables of population, density, number of hospitals, and number of the Community Health Center were positively related to the number of doctors. The results of this study were important as a basis for the policy of the doctors' redistribution in Indonesia.

The elderly are one of the most vulnerable groups with very high dependency rates. This condition has the potential to cause other problems for the caregiver or his family. The elderly also has the potential to suffer from catastrophic diseases that have costly consequences. This research is a further analysis of Riskesdas 2013 data, that presented in descriptive quantitative. The results showed that elderly people living in urban as well as rural areas have a tendency of moderate access barrier to Puskesmas. There are still 15% of very poor elderly people who have major access barrier to Puskesmas. This study concludes that although elderly access to Puskesmas is quite good, but the access of very poor elderly is still need more attention. The government needs to provide basic health care facilities in more rural areas. The government also needs to realize a National Health Insurance with tax-based funding, to ensure universal coverage regardless of the ability to pay the community. Abstrak Lansia adalah salah satu kelompok rentan yang memiliki angka ketergantungan sangat tinggi. Kondisi ini berpotensi menimbulkan masalah lain bagi yang merawat atau keluarganya. Lansia juga berpotensi menderita penyakit katastropik yang menimbulkan konsekuensi biaya yang mahal. Penelitian ini merupakan analisis lanjut data Riskesdas 2013, yang disajikan secara deskriptif kuantitatif. Hasil penelitian menunjukkan bahwa lansia yang tinggal di perkotaan maupun perdesaan mempunyai kecenderungan hambatan akses sedang untuk ke Puskesmas. Masih ada 15% lansia sangat miskin yang memiliki hambatan besar ke Puskesmas. Penelitian ini menyimpulkan bahwa meski akses lansia ke Puskesmas sudah cukup baik, tetapi akses lansia yang sangat miskin masih perlu mendapat perhatian lebih. Pemerintah perlu menyediakan fasilitas pelayanan kesehatan dasar di wilayah perdesaan yang lebih banyak. Pemerintah juga perlu mewujudkan sebuah Jaminan Kesehatan Nasional dengan pendanaan berbasis pajak, untuk memastikan cakupan secara universal dengan tanpa menghiraukan kemampuan membayar masyarakat.

ABSTRAK Anak balita merupakan periode masa yang disebut golden age. Akses pelayanan kesehatan untuk kelompok ini menjadi perhatian karena kesinambungan hidup pada kelompok tersebut menjadi salah satu tolok ukur pembangunan kesehatan. Penelitian ini merupakan analisis lanjut data Riskesdas 2013, yang disajikan secara deskriptif kuantitatif. Analisis dilakukan pada variabel-variabel cakupan kunjungan balita ke pelayanan kesehatan. Pelayanan kesehatan dimaksud adalah Rumah Sakit, Puskesmas/Pustu, Praktik Dokter/Klinik, dan Polindes/Praktik Bidan. Hasil penelitian menunjukkan bahwa balita yang tinggal di perkotaan dan pada kelompok kaya dan sangat kaya memiliki akses yang lebih baik di Rumah Sakit dan praktik dokter/klinik pada akses rawat jalan dan rawat inap. Sementara mereka yang tinggal di perdesaan dan pada kelompok miskin memiliki akses yang lebih baik ke Puskesmas/Pustu dan Polindes/praktik bidan baik di rawat jalan maupun rawat inap. Berdasarkan hasil penelitian dapat disimpulkan bahwa balita yang tinggal di perkotaan dan pada kelompok kaya memiliki akses yang lebih baik pada pelayanan kesehatan rujukan, sementara mereka yang tinggal di perdesaan dan pada kelompok miskin memiliki akses yang lebih baik di fasilitas pelayanan kesehatan dasar. Kata kunci: akses, pelayanan kesehatan, balita ABSTRACT Toddler is a period of time called golden age. Access to health services for this group is a concern because the continuity of life in the group is one of the benchmarks for health development. This research is an advance analysis of the Riskesdas 2013, which is presented in quantitative descriptive manner. Analysis was carried out on the variables of coverage of toddler visits to health services. The intended health services are hospitals, health center/Pustu, doctor/clinic, and Polindes/midwife, both on outpatient visits and inpatients. The results showed that toddlers who lived in urban areas and in the rich and very rich groups had better access in hospitals and doctor/clinic practices on access to outpatient and inpatient care. While those who live in rural areas and the poor have better access to health center/Pustu and Polindes/ midwives both in outpatient and inpatient care. Based on the results of the study it can be concluded that toddlers who live in urban areas and in rich groups have better access to referral health services, while those who live in rural areas and in poor groups have better access to basic health care facilities. Keyword: access, health services, toddler

One indicator to see the quality of health system performance was to look at the disparity in the utilization of healthcare facilities. The research objective was to analyze the disparity between regions in the utilization of health centers in rural areas in Indonesia. The results of the 2013 Basic Health Survey (Riskesdas) were used as analysis material. The 2013 Riskesdas was designed a cross-sectional survey. Respondents obtained 388,598 using the multi-stage cluster random sampling method. Binary Logistic Regression Test was used to analyze data. Data is obtained through a structured questionnaire. The results showed that there were statistically significant disparities between regions. All regions showed better utilization than the Papua region as a reference. The best utilization was in the Sumatra region, which was 3.781 times more utilizing health centers than the Papua region (OR = 3.781; 95% CI = 3.580-3.993). The utilization of health centres that approached the Papua region was the Nusa Tenggara region (OR = 1.582; 95% CI = 1.490-1.679) and the Maluku region (OR = 2.175; 95% 1.999-2.366). All three regions are all in the Eastern part of Indonesia. The research concluded there was a disparity in health center utilization between regions in rural Indonesia. Regions in the western part of Indonesia tend to have better health center utilization in rural areas. Research results could be used as a reference for making policies that focus on equality of services to reduce existing disparities.

ABSTRAK Latar Belakang: Kajian yang fokus pada capaian kinerja KIA berdasarkan input rasio tenaga bidan penting sebagai langkah untuk melakukan evaluasi. Penelitian ditujukan untuk menjawab hubungan antara rasio bidan sebagai input dengan cakupan program pelayanan KIA sebagai output. Metode: Sumber data sekunder dari "Data dan Informasi: Profil Kesehatan Indonesia tahun 2017". Analisis melibatkan Rasio Bidan/100.000 penduduk sebagai variabel independent, dan 5 variabel dependen, yaitu K1, K4, KN, KF dan Persalinan yang Ditolong oleh Tenaga Kesehatan. Analisis hubungan dilakukan melalui diagram scatter plot. Hasil: Rasio bidan sesuai standar cenderung ada di wilayah Barat. Variabilitas rasio bidan lebar, dari 41,53 sampai 225,90 bidan per 100.000 penduduk. Provinsi DKI Jakarta, Jabar, dan NTB yang memiliki cakupan K1 di atas 100%, meski rasio bidan di bawah standar. DKI Jakarta dan Jambi memiliki cakupan K4 di atas 100%. Perbedaannya, Jambi memiliki rasio bidan di atas standar (123,58), sementara DKI Jakarta belum (48,70). Cakupan KN di atas 100% dicapai oleh 4 provinsi, yaitu DKI Jakarta, Jabar, Jambi dan Bali. Kaltara dan DKI Jakarta memiliki cakupan KF di atas 100%, bedanya Kaltara memiliki rasio bidan di atas standar, DKI Jakarta belum. Tidak ada satu pun provinsi, kecuali DKI Jakarta, yang memiliki cakupan Persalinan oleh Tenaga Kesehatan di atas 100%. Kesimpulan: Meski memiliki rasio bidan yang masih di bawah standar, beberapa provinsi mampu menunjukkan kinerja program KIA yang lebih baik dibanding yang sudah memenuhi rasio. Saran: Perlu lebih lanjut dengan melakukan benchmark pada provinsi yang memiliki kinerja program KIA baik, meski dengan rasio bidan di bawah standar. Kata Kunci: rasio tenaga bidan, program KIA, distribusi tenaga kesehatan, evaluasi

Introduction: Hospitals were advanced referral health facilities or referrals for basic health services, it was very important for policymakers to know the factors that were able to predict hospital use Aim. The research objective was to determine the predictors of hospital use among Papuans in Indonesia. Method: Data source from subset data of the 2013 Basic Health Survey. Basic Health Survey was a cross-sectional survey. The multi-stage cluster random sampling method was used to get 30,620 Papuan respondents. Multinomial Logistic Regression Test is used to determine the predictors of hospital utilization. Results: There were 8 predictors of hospital utilization in outpatients used consisting of age, urban-rural area, gender, education level, socioeconomic status, insurance ownership, travel time and transportation costs, there were 5 predictor variables in hospital utilization in patients hospitalization consisting of gender, type of work, socioeconomic status, travel time and transportation costs, and there were 2 predictors in hospital utilization in outpatient and inpatient care at the same time consisting of the cost of time travel and transportation to the hospital. Conclusion: Overall there were 9 predictor variables of hospital utilization in all categories (outpatient and inpatient).

Background: Equal access to healthcare facilities, patient's satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas. Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests. Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 - 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 - 1.255). While for the category of hospital inpatient utilization, there was no significant difference. Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care.

One indicator to see the quality of health system performance was to look at the disparity in the utilization of healthcare facilities. The research objective was to analyze the disparity between regions in the utilization of health centers in rural areas in Indonesia. The results of the 2013 Basic Health Survey (Riskesdas) were used as analysis material. The 2013 Riskesdas was designed a cross-sectional survey. Respondents obtained 388,598 using the multi-stage cluster random sampling method. Binary Logistic Regression Test was used to analyze data. Data is obtained through a structured questionnaire. The results showed that there were statistically significant disparities between regions. All regions showed better utilization than the Papua region as a reference. The best utilization was in the Sumatra region, which was 3.781 times more utilizing health centers than the Papua region (OR = 3.781; 95% CI = 3.580-3.993). The utilization of health centres that approached the Papua region was the Nusa Tenggara region (OR = 1.582; 95% CI = 1.490-1.679) and the Maluku region (OR = 2.175; 95% 1.999-2.366). All three regions are all in the Eastern part of Indonesia. The research concluded there was a disparity in health center utilization between regions in rural Indonesia. Regions in the western part of Indonesia tend to have better health center utilization in rural areas. Research results could be used as a reference for making policies that focus on equality of services to reduce existing disparities.

ABSTRAK. Hasil Riskesdas tahun 2007, 2013 dan 2018 menunjukan angka stunting pada balita masih di atas 30%. Sementara kemiskinan dibuktikan seringkali hadir bersamaan dengan terjadinya stunting pada balita. Gizi yang adekuat pada masa hamil dan pengawasan kesehatan ibu hamil melalui pelayanan antenatal care dinilai merupakan salah satu upaya sensitif dalam penanggulangan stunting. Studi ini ditujukan untuk menjawab apakah faktor kemiskinan dan ketersediaan layanan kesehatan berhubungan dengan prevalensi balita stunting di provinsi di Indonesia. Penelitian ini merupakan analisis lanjut data sekunder "Data dan Informasi: Profil Kesehatan Indonesia tahun 2017". Data dianalisis secara deskriptif dengan tabulasi silang. Hasil penelitian menunjukkan bahwa pada kategori persentase penduduk miskin yang tinggi (> 14,43%) didominasi oleh prevalensi balita stunting yang tinggi (22,51%-30,0%). Pada kategori rasio Puskesmas per 100 ribu penduduk tinggi (≥ 4) terlihat didominasi oleh prevalensi balita stunting pada kategori tinggi (22,51%-30,0%). Pada kategori rasio tenaga gizi per 100 ribu penduduk tinggi (> 12) justru terlihat didominasi oleh prevalensi balita stunting kategori tinggi (22,51%-30,0%). Pada kategori rasio tenaga bidan per 100 ribu penduduk tinggi (> 97) didominasi oleh prevalensi balita stunting kategori tinggi (22,51%-30,0%). Disimpulkan bahwa persentase penduduk miskin berhubungan secara positif dengan prevalensi balita stunting. Sementara faktor input pelayanan kesehatan (Puskesmas, tenaga gizi, dan tenaga bidan) tidak berhubungan dengan prevalensi balita stunting. Disarankan pemerintah lebih memfokuskan sasaran kebijakan pada masyarakat miskin. Kata Kunci: balita, stunting, profil kesehatan, kemiskinan

ABSTRAK Anak balita merupakan periode masa yang disebut golden age. Akses pelayanan kesehatan untuk kelompok ini menjadi perhatian karena kesinambungan hidup pada kelompok tersebut menjadi salah satu tolok ukur pembangunan kesehatan. Penelitian ini merupakan analisis lanjut data Riskesdas 2013, yang disajikan secara deskriptif kuantitatif. Penulisan artikel ini bertujuan untuk mengetahui gambaran akses pelayanan kesehatan pada kelompok balita di Indonesia. Analisis dilakukan pada variabel-variabel cakupan kunjungan balita ke pelayanan kesehatan. Pelayanan kesehatan dimaksud adalah Rumah Sakit, Puskesmas/Pustu, Praktik Dokter/Klinik, dan Polindes/Praktik Bidan. Hasil penelitian menunjukkan bahwa balita yang tinggal di perkotaan dan pada kelompok kaya dan sangat kaya memiliki akses yang lebih baik di Rumah Sakit dan praktik dokter/klinik pada akses rawat jalan dan rawat inap. Sementara mereka yang tinggal di perdesaan dan pada kelompok miskin memiliki akses yang lebih baik ke Puskesmas/Pustu dan Polindes/praktik bidan baik di rawat jalan maupun rawat inap. Berdasarkan hasil penelitian dapat disimpulkan bahwa balita yang tinggal di perkotaan dan pada kelompok kaya memiliki akses yang lebih baik pada pelayanan kesehatan rujukan, sementara mereka yang tinggal di perdesaan dan pada kelompok miskin memiliki akses yang lebih baik di fasilitas pelayanan kesehatan dasar. Kata kunci: akses, pelayanan kesehatan, balita

Introduction. Equal access to healthcare facilities, patient's satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. The research aims to prove the existence of disparities hospital utilization based on the category of urban-rural areas. Materials and Methods. The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material. The 2013 RKD was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests. Respondent obtained by structured questionnaire. Result. The result showed adults living in urban areas were likely to use hospital outpatient facilities 1,246 times higher than adults living in rural areas (OR 1,246; 95% CI 1,026-1,030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1,134 times higher in adults living in urban areas than those in rural areas (OR 1,134; 95% CI 1,025-1.255). While for the category of hospital inpatient utilization, there was no significant difference. Conclusions. There was a disparity in hospital utilization between urban and rural areas. Urban areas show better utilization than rural areas in outpatient and at the same time the use of inpatient care in Indonesia.

The pattern of diseases in the elderly people usually is degenerative diseases which often catastrophic and high cost. Unfortunately, a large financial intervention is often having the wrong target, precisely because of the more utilized by high socioeconomic groups. This article is devoted to an analysis of hospital utilization disparity based on the socioeconomic status on the elderly in Indonesia. The data processed from the 2013 Indonesian Basic Health Survey (Riskesdas) with a sample size of 199,653 elderlies. Estimation by using multinomial logistic regression test used to explore the disparity between socioeconomic characteristics of the elderly in hospital utilization. Quintile 1 likelihood 0.355 times utilizing hospital outpatient than quintile 5 (OR 95% CI; 0.355 0.302-0.418). Quintile 1 likelihood 0.414 times utilizing hospital inpatient than quintile 5 (OR 95% CI; 0.414 0.366-0.468). Quintile 1 likelihood 0.247 times utilizing outpatient inpatient at once than quintile 5 (OR 95% CI; 0.247 0.184-0.332). The better the socioeconomic status is getting better the hospital utilization of the elderly. INTRODUCTION The elderly is one of the groups that are vulnerable according to the attention of the World Health Organization (WHO). Other vulnerable groups are children, pregnant women, people who are malnourished, and people who are ill or impaired immune 1. The elderly is getting increase and require more attention as an impact of the development of better health. Indonesia's population dynamics also shifted towards the population elderly groups. As evidence is the life expectancy in Indonesia that is continually increasing. The year 2010 life expectancy 69.81 years. The number then rose to 70.90 years (man 69.09 years, women 72.8 years) in 2016. Life expectancy 70.90 years showed that babies born in the year 2016 can live up to 70 years of age 2 .

Madurese communities often have a low public health status. These could be seen from the health development achievements four regencies on the island. This research was intended to analyze the determinant of the Puskesmas utilization in Madura Island. The Data derived from the 2013 Riskesdas. The analysis using binary logistic regression to examine the determinant of the Puskesmas utilization. The results of the study showed the Madurese in Bangkalan likelihood 2,120 times more utilize the Puskesmas than in Sumenep (OR 2.120; 95% CI 1.448-3.105). Madurese in Pamekasan 1.410 times more likely to utilize the Puskesmas than in Sumenep (OR 1.410; 95% CI 1.025-1.940). Age affects the Puskesmas utilization, while rurality did not show a significant influence. Those who pass the primary school were likelihood 0.225 times to utilize of Puskesmas than the graduates of the college (OR 0.225; 95% CI 0.054-0.946). The Madurese in quintile 4 seen has no difference from those in quintile 5. While the Madurese who insured likelihood 0.650 times to utilize the Puskesmas than who not insured (OR 0.650; 95% CI 0.517-0.818). The Madurese that has a shorter time to the Puskesmas likelihood 0.616 times more utilize than that have a long time (OR 0.616; 95% CI 0.479-0.791). The research concluded that from 9 factors related to the Puskesmas utilization in Madura Island, there are 7 factors that are determinants, namely the regency, age, education, work status, socioeconomic, insurance, and travel time.

Access to health services is often seen only from the provider perspective, while from the community side as a user is less noticed. Improving the quality of health services access requires a complete perspective on two different sides. This research is designed descriptively qualitative. Data were collected by Focus Group Discussion (FGD), in-depth interview and observation. The research was conducted in Malang Regency in June-August 2018. The study results showed health services access generally the community believes that there are still perceived defi ciencies. Especially on the aspect of physical access, due to poor facilities and infrastructure. In addition, social access was also considered inadequate, because there were still health workers who served with less friendly. This study concludes that people still feel access to physical and social aspects is still difficult. It should be recommended to the local government for efforts to improve physical access, and the Health Office to disseminate health information about the rights of patients to the community.

The elderly are one of the most vulnerable groups with very high dependency rates. This condition has the potential to cause other problems for the caregiver or his family. The elderly also have the potential to suff er from catastrophic diseases that have costly consequences. This research is a further analysis of Riskesdas 2013 data that presented in descriptive quantitative. Three barriers variables were analyzed, i.e. two physical constraints (travel time and transportation cost) and one economic barrier (insurance ownership). The results showed that elderly people living in urban as well as rural areas have a tendency of moderate access barrier to health center. There were still 15% of very poor elderly people who have major access barrier to health center. This study concludes that although elderly access to health center is quite good, the access of very poor elderly still needs more attention. The government needs to provide primary health care facilities in more rural areas. The government also needs to realize a National Health Insurance with tax-based funding, to ensure universal coverage regardless of the community’s ability to pay.

Background: Indonesia has an important progress in community health status improvement. J.e infant mortality rate maternal mortality rate, and life expectancy. However, amongs the A SEAN country these indicator were worse wlfhm the member. Since monetary crisis in 1997, difficulty of family economic decreased nutrition status of child. Th1s situation shows Indonesia still have many problems about mother and children health. In other side, posyandu/poskesdes have played an important role to deli very primary health care for mother and child. The availability of serv1ces without optimalizatton of utility will be nothing in effort to increase health status of mother and child. Based on these background, this research aims to determine factors that have relationship with posyandulposkesdes utilization. Methods: This research design was cross sectional survey. Raw data of Riskesdas 2007 was used in this research. Data was analyzed by binary logistic regression to detem1ine posyandulposkesdes utilization. Resul ts : These study has shown that the ma;onty of respondents 73, 5% of 238.463 family never visit Posyandu!Poskesdes in three monl/1last. This research fainded significant relationship between posyandulposkesdes utilization with geographic location, family head characteristics. the number of children and reproductive woman household, and level of economic. The study recommended that in improving posyandulposkesdes government has to consider predictor variabels of posyandulposkesdes utilization as result of this research to guarantee of sustainability. To increase research focused, questionnaires of Riskesdas in the future must be divide questions about posyandu and poskesdes utilization.

Aksesibilitas fasilitas kesehatan di kepulauan, tidak akan pernah terlepas atau bahkan sangat tergantung dengan ketersediaan sarana transportasinya. Jumlah Puskesmas untuk memberikan pelayanan dasar kepada masyarakat sudah mencukupi. Namun, keterbatasan tenaga mengakibatkan Puskesmas tidak cukup mampu memberikan pelayanan secara optimal. Chapter ini mengupas secara detail sebagai studi kasus pada tiga wilayah kepulauan yang berbeda.

Buku ini mencoba menelisik kesenjangan yang terjadi antara wilayah kabupaten dengan kota, dan antara wilayah miskin dan non miskin pada semua pelayanan kesehatan yang tersedia, baik tenaga maupun fasilitas pelayanan kesehatan. Hasilnya menunjukkan bahwa memang pada hampir semua kategori kesenjangan tersebut tengah terjadi. Kesenjangan tidak terjadi hanya pada sisi supply antara daerah miskin dan non miskin saja. Secara studi kasus, buku ini juga mengupas secara detail tentang aksesibilitas di Kabupaten Gresik dan Kabupaten Maluku Tenggara Barat. Sisi supply, barrier maupun demand, dibahas dengan melibatkan data laporan rutin, data survei Riskesdas dan Rifaskes serta pandangan dari para policy maker di tingkat kabupaten maupun dari para pelaku lapangan secara langsung.