Abstract
BackgroundIn the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors.MethodsWe conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs’ knowledge and attitude with performance as gatekeepers.ResultsGPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score.ConclusionGPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.
Highlights
In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population
Our study described how general practitioners (GPs) in the Indonesian Banyumas district perceive the gatekeeper role of primary care and it explored whether those perceptions were associated with personal characteristics of the General practitioner (GP) or with characteristics of the facilities
We found no personal or facility characteristics that were significantly associated with the GPs’ knowledge about the gatekeeper function of primary care, privately employed GPs tended to higher knowledge scores than those practising in public facilities
Summary
In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. In the wake of the rapid expansion of National Health Insurance (NHI) coverage during recent years, the utilisation of secondary care depends largely on the functioning of primary care [2]. In the NHI-funded healthcare delivery system, direct access to secondary care is not covered except in emergency cases. By 2017, around 72% of the Indonesian population, or 177 million people, were covered by NHI, and the health insurance agency had contracted approximately 21,700 primary care facilities to provide beneficiaries with healthcare and gatekeeping services [4]. The NHIfunded healthcare delivery system in Indonesia is the largest single-payer system in the world [4]
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