TY - JOUR
T1 - Determinants of out-of-district health facility bypassing in East Java, Indonesia
AU - Putri, Nuzulul Kusuma
AU - Wulandari, Ratna Dwi
AU - Syahansyah, Robeth Jabbar
AU - Grépin, Karen A.
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background: Several large-scale reforms, including policies aimed at achieving universal health coverage, have been implemented to overcome health disparities in Indonesia. However, access to health services remains unequal. Many people 'bypass' health services in their home district to access health services in neighbouring districts, even though their health insurance does not cover such services. This study aims to identify the factors that are associated with this out-of-district bypassing behaviour. Methods: We surveyed 500 respondents living in the outermost districts of East Java province. We used data on education, income, district, age, gender, household size, district accessibility, insurance coverage status and satisfaction with health facilities in the home district and logistic regression analysis to model the predictors of out-of-district health facility bypassing. Results: The most important predictors of the bypassing behaviour were education and poor access to health facilities in the home district. Open-ended data also found that the most important reason for seeking care in another district was mostly geographic. In contrast, health insurance coverage does not appear to be a significant predictor. Conclusions: Education and geographic factors are the main predictors of out-of-district bypassing behaviour, which appears to be how border communities express their health facility preferences. Local and central governments should continue their work to reduce inequality in access to health facilities in Indonesia's geographically challenged districts.
AB - Background: Several large-scale reforms, including policies aimed at achieving universal health coverage, have been implemented to overcome health disparities in Indonesia. However, access to health services remains unequal. Many people 'bypass' health services in their home district to access health services in neighbouring districts, even though their health insurance does not cover such services. This study aims to identify the factors that are associated with this out-of-district bypassing behaviour. Methods: We surveyed 500 respondents living in the outermost districts of East Java province. We used data on education, income, district, age, gender, household size, district accessibility, insurance coverage status and satisfaction with health facilities in the home district and logistic regression analysis to model the predictors of out-of-district health facility bypassing. Results: The most important predictors of the bypassing behaviour were education and poor access to health facilities in the home district. Open-ended data also found that the most important reason for seeking care in another district was mostly geographic. In contrast, health insurance coverage does not appear to be a significant predictor. Conclusions: Education and geographic factors are the main predictors of out-of-district bypassing behaviour, which appears to be how border communities express their health facility preferences. Local and central governments should continue their work to reduce inequality in access to health facilities in Indonesia's geographically challenged districts.
KW - access
KW - bypassing
KW - district
KW - health insurance
UR - http://www.scopus.com/inward/record.url?scp=85122339067&partnerID=8YFLogxK
U2 - 10.1093/inthealth/ihaa104
DO - 10.1093/inthealth/ihaa104
M3 - Article
C2 - 33503654
AN - SCOPUS:85122339067
SN - 1876-3413
VL - 13
SP - 545
EP - 554
JO - International Health
JF - International Health
IS - 6
ER -