The evolution of income-related inequalities in healthcare utilisation in Indonesia, 1993–2014

ObjectiveWhile the major policy changes in the Indonesian healthcare system over the last 25 years have been well documented, less is known about the accompanying changes in inequalities in healthcare utilisation during this period. Our study aimed to describe the trends in income-related inequalities in healthcare utilisation in Indonesia during the period 1993–2014.MethodsA repeated cross-sectional study was conducted using data from the Indonesian Family Life Surveys from 1993, 2000, 2007, and 2014. We measured outpatient and inpatient healthcare utilisation in public and private provider as well as the overall utilisation. Standardised prevalence rate and relative index of inequality (RII) were used to measure the extent of inequalities in healthcare utilisation by income level (income-related inequalities).ResultsRelatively large income-related inequalities were observed in the utilisation of private outpatient care and public and private inpatient care in 1993. Income-related inequalities in public and private outpatient care utilisation decreased between 1993 and 2007 but increased in 2014. Income-related inequalities in public and private inpatient care utilisation continued to decrease between 1993 and 2014. The largest decrease was observed in private inpatient care utilisation.ConclusionIncome-related inequalities in all types of healthcare utilisation decreased until 2007. This trend continued until 2014 only for public and private inpatient care utilisation. This phenomenon may be explained by the changes to the healthcare system (e.g. expansion of the government health insurance programme and health sector decentralisation), which coincided with the changes in inequalities in healthcare utilisation in Indonesia.

研究目的：尽管过去25年间印尼医疗体系的重大政策变革已有充分文献记载，但同期医疗服务利用伴随发生的收入相关不公平性变化却鲜为人知。本研究旨在描绘1993至2014年间印尼医疗服务利用的收入相关不公平性变化趋势。
研究方法：本研究采用重复横截面研究设计，使用1993、2000、2007及2014年印尼家庭生活调查（Indonesian Family Life Surveys）数据开展分析。我们对公立与私立医疗机构的门诊、住院医疗服务利用情况及总医疗服务利用量进行了测算。采用标准化患病率及相对不公平指数（Relative Index of Inequality, RII）来衡量按收入水平划分的医疗服务利用不公平程度（收入相关不公平性）。
研究结果：1993年，私立门诊医疗服务、公立及私立住院医疗服务的利用均存在较为显著的收入相关不公平性。1993至2007年间，公立与私立门诊医疗服务利用的收入相关不公平性有所下降，但2014年该差距出现回升。1993至2014年间，公立与私立住院医疗服务利用的收入相关不公平性持续下降，其中私立住院医疗服务利用的不公平性降幅最大。
研究结论：截至2007年，各类医疗服务利用的收入相关不公平性均有所降低。仅公立与私立住院医疗服务利用的公平性改善趋势延续至2014年。这一现象可由印尼医疗体系的变革（例如政府健康保险计划扩容及医疗部门分权改革）得到解释，这些变革与印尼医疗服务利用不公平性的变化时间高度重合。