Who Experience Out-of-Pocket Expenditures for Modern Contraceptive Use in Indonesian Universal Health Coverage System?

Abstract

Integration of family planning programs into the universal health coverage system is expected to improveaccess toreproductive health services. All people should have access to sufficient and qualified family planningservices they need without financial hardship. This study aimed to examine out-of-pocket expenditures ofcontraceptive services and the associated factors among fertile age couples that influence their access tomodern contraceptive services.It was quantitative research with a cross-sectional design. Data obtained fromthe Health and Demographic Surveillance System 2016 of Sleman Regency, Indonesia, were analyzed usingmultiple logistic regression to determine factors associated with out-of-pocket expenditures for contraceptiveservices. This study revealed that more than 70% of people should pay for contraceptive services eventhough they had registered as health insurance members. Public non-subsidized and private health insurancemembers were more likely to experience OOP expenditures than public-subsidized participants (AOR=3.12;95%CI=2.25-4.30 and AOR=3.47; 95%CI=1.60-7.52, respectively). Short-term contraception users weremore likely to experience out-of-pocket expenditures thanlong-term users(AOR=6.38; 95%CI=4.79-8.50).Nearly three-quarters of health insurance participants experience out-of-pocket expenditures forcontraceptive services. Out-of-pocket expenditures of contraceptive services significantly associate with thetype of health insurance owned and the types of contraceptive methods used.