ArticleBMC public health2026
Hidden inequities in universal health coverage: determinants of health insurance underutilization in Indonesia.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUniversal health coverage (UHC) requires not only insurance enrolment but also effective use of coverage. In Indonesia, despite near-universal enrolment in the National Health Insurance programme (Jaminan Kesehatan Nasional, JKN), many insured individuals do not use their insurance when seeking care. Evidence on the extent and determinants of this underutilisation remains limited.
methodsWe analysed nationally representative data from the 2023 National Socioeconomic Survey (SUSENAS), including insured individuals who reported outpatient care in the past month or inpatient care in the past 12 months. Insurance underutilisation was defined as the non-use of JKN during a healthcare encounter among those insured. Guided by Andersen’s Behavioral Model, we estimated random-effects logistic regression models for outpatient and inpatient care, incorporating individual, household, and district-level health system factors and accounting for clustering at the district level.
resultsAmong insured individuals, 48.3% did not use JKN for outpatient care, compared with 11.0% for inpatient care. In adjusted models, outpatient non-use was higher among self-employed (aOR 1.43), casual (aOR 1.54), and unpaid family workers (aOR 1.42) than among those not working, and increased with income (highest vs. lowest quartile: aOR 1.34). Rural residents were more likely to underutilise outpatient insurance (aOR 1.47), while higher education was protective (university vs. elementary: aOR 0.77). Greater hospital (aOR 0.28) and primary care density (aOR 0.86) reduced outpatient non-use. For inpatient care, non-use remained associated with self-employment (aOR 1.29), high income (aOR 1.56), rural residence (aOR 1.25), and lower hospital density (aOR 0.21). Between-district differences explained 21% of outpatient and 14% of inpatient variation.
conclusionsSubstantial inequities persist in the effective use of JKN, particularly for outpatient care. Addressing labour-market constraints, opportunity costs, administrative barriers, and local service capacity is essential to translate coverage into equitable access.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.