National health insurance impact on malnutrition in under-five years old children in Indonesia

Abstract

Abstract Background The premium-based National Health Insurance Program under Jaminan Kesehatan Nasional (JKN), has been launched in 2014, although it lacks evaluation of the benefits, particularly on clinical outcomes-based. This study aimed to assess the impact of JKN possession on nutrition status among under-five years old children. Methods A Cross-Sectional Study was conducted during January-September 2019 in Balikpapan, Indonesia to assess the impact of JKN in the nutrition status of this specific group. Primary data (socio-demographic, feeding pattern, basic knowledge of nutrition and Health Insurance ownership) has retrieved through validated questionnaires from the parents and/or the guardian, followed by anthropometry measurement (Weight per Age Z-Score) to determine the nutrition status. Bivariate analysis was conducted to identify the confounder. Binary Logistic Regression was performed to determine the impact of JKN health insurance on the nutrition status among the target population Results As 62 from 312 (19.87%) children fall <-2 Z-Score (Underweight) whereas 5 children were overweight (>2 Zscore) and 2 children were obese (>3 Z Score). Only 77 (24.68%) children have JKN. The education of both parents was associated with nutrition status but no difference in knowledge regarding nutrition and identifying nutritional disease. Various feeding patterns (Breastfeeding status, vitamin A status, and snack intake) were not potential confounders. Adjusted by birth weight and history of disease within 6 months, child who possess Health Insurance (JKN) tend to have a normal weight child up to 1.998 times (AOR = 1.998, 95% CI 1.056-3.780 p = 0.033) compared to underweight, but no significant finding was found between Health Insurance and children with normal and overweight/obese children, adjusted by birthweight (AOR = 3.091, 95% CI 0.639-14.692 p = 0.161) Conclusions This study illustrated the significant benefit of JKN to prevent undernourished event but not overnutrition. Key messages National Health Insurance Coverage provides benefit on malnutrition prevention in under-five years old children. Children covered with National Health Insurance will unlikely get undernourished but no significant finding in overnourished prevention.