Health System Coverage Research Articles

10-year opportunistic mammographic screening scenario in Brazil and its impact on breast cancer early detection: a nationwide population-based study.

BackgroundMammographic screening has been used to reduce breast cancer mortality worldwide and remains the main modality for the early detection of this disease. Women from low- and middle-income countries still lack access to periodic mammograms and efficient health care. This cross-sectional study aimed to explore opportunistic mammographic coverage in Brazil, while considering the privately insured population and its association with early breast cancer (EBC) detection.MethodsData on population, gross domestic product (GDP), number of mammograms performed under the Sistema Único de Saúde (SUS) public health system or private system, and women diagnosed with early-stage breast cancer from 2010 to 2019 were retrieved from publicly available databases.ResultsA total of 39 555 636 mammograms with an average of 3 955 564 ± 395 704 mammograms were obtained per year from 2010 to 2019 in Brazil. Most examinations (58.6%) were performed in the target population (50-69 years old), while 32% were performed in women aged 40-49, and 9.4% were performed in women <40 years or >70 years of age. The 10-year mammogram coverage was 30.6% in the target population and 24.8% in the population aged 40-49 years, with significant variation across states and municipalities. The overall EBC detection rates in Brazil were 30.6% in populations aged 50-70 and 24.8% in those aged 40-50 years. We observed a positive correlation between coverage and EBC detection rate (r = 0.68; P = 0.0001 (50-70 years) and r = 0.75; P < 0.0001 (40-50 years)). According to the GDP, the municipalities with higher GDP per capita had higher mammogram coverage (P < 0.0001).ConclusionsThe coverage of mammographic screening for women under the SUS is far below the international guidelines. Additionally, a significant number of mammograms have been performed in non-target populations. This scenario reflects the problematic screening programs in developing countries and reflects low rates of EBC diagnosis. As Brazil is a continental country with heterogeneous socioeconomic indicators, we observed significant variations in the number of mammograms performed by age groups when separated by states and municipalities. Even when considering supplemental health system coverage, municipalities with higher GDP per capita were associated with higher mammogram coverage.

‘It never rains, but it pours’–Disasters triggered by natural hazards, sexual risk-taking behavior, and the role of health systems: A worldwide ecological analysis

Natural hazards have become more frequent and more severe as a result of climate change. Their increasing impact has a negative effect on people's health, including mental health. The aim of this ecological study is to investigate the association between exposure to disasters triggered by natural hazards and higher sexual risk-taking behavior as measured by one of its consequences, increased human immunodeficiency virus (HIV) incidence, at the country-level, worldwide. All data were extracted from publicly available sources. Crude and adjusted linear regression models were built to explore the association between the proportion of people affected by natural hazards and HIV incidence. Multivariable models included socio-demographic variables (literacy, income and age), and therapy coverage and the healthcare access and quality index. In the crude regression model, the total number of people affected by natural hazards over a 5 year time period is positively associated with HIV incidence. For every 10 new people per 100,000/year affected by natural hazards, the HIV incidence in the country was 1.5 higher per 1,000 uninfected. However, when adjusting for socio-demographic variables, the association is lost. In the fully adjusted multivariable model, only antiretroviral therapy coverage and health care access and quality were significantly positively and negatively associated with HIV incidence. No interaction was found by income groups, world regions or categories of high and low HIV prevalence. No association between exposure to natural hazards and increased sexual risk-taking behavior at country level worldwide was detected after accounting for socio-demographic variables. Nonetheless, countries with a higher proportion of the population affected by disasters triggered by natural hazards were also those witnessing a higher incidence rate of HIV, possibly through the mediating effect of disrupted health system coverage, highlighting the coexistence of different vulnerabilities for public health.

The Strategic Plan of the Japan Pharmaceutical Association, The Aspect of a Super Aged Society

The anticipation of Japan's decreased birthrate and a shift to an aged society has led to the field of medical care to review the country's social security system. The review calls for a reform of the medical insurance system under the universal health coverage system to fit the changing demographic. The target year of 2025 has the government advocating for an "integrated community care system", with the 'baby-boom generation' turning 75. This is a sustainable regional system that can cope with the aging society and the declining birthrate simultaneously. Within this new system, I would like to discuss The Strategic Plan of the Japan Pharmaceutical Association, released with the aim of realizing pharmacists and pharmacy services that can immediately respond to the expectations of society; from the perspective of the theme of this symposium, "Communicating the image of pharmacists in a community-based society".

Antihypertensive medicine use differs between Ghana and Nigeria

BackgroundNon-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source.MethodsWe used data from mPharma—a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product.ResultsAHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria.ConclusionThe differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community.

Technical efficiency of health production in Africa: A stochastic frontier analysis

Background: Inefficiency is widespread in health systems all over the world. The World Health Organization (WHO) estimates that 20%-40% of the global health spending is wasted. In African countries, inefficiency of this magnitude will seriously hamper progress towards achieving universal health coverage and other health system goals. It is thus, significant to assess the efficiency of health systems over time in order to set the ground for identifying the contextual factors leading to inefficiency and design appropriate efficiency-enhancing measures.Methods: Using panel data for the years 2000, 2005, 2010, and 2015, the study employs a time-variant stochastic frontier production function to assess efficiency. The input measure used is current expenditure per capita in purchasing power parity (Int$) terms and the measure of output is health-adjusted life expectancy (HALE). Moreover, mean years of schooling, GDP per capita in Int$, and out-of-pocket payment as a share of current expenditure on health were used as technical inefficiency effect variables. Data were analyzed using Frontier Version 4.1.Results: The mean technical efficiency scores were 79.3% in 2000, 81% in 2005, 85.6% in 2010 and 88.3% in 2015. Over the four periods of time, Cabo Verde registered the highest technical efficiency scores, while Eswatini and Sierra Leone had the lowest. The minimum technical efficiency scores were 58.7% (in 2000), 59.1% (2005), 67.4% (2010) and 71.8% (2015). These indicate that despite improvements, there is a significant degree of technical inefficiency. Most of the countries among those in the bottom 10% efficiency scores are countries in Southern Africa, which in 2015 had a very high prevalence of HIV among adults, compared to the top 10%, which had prevalence rates of less than 0.1%.The mean efficiency score increased progressively over time – a nine percentage point increase between 2000 and 2015. The elasticity of current health expenditure was positive (0.06) and statistically significant. All the technical inefficiency variables had no statistically significant effect.Conclusions: Over the period of time covered in this study, there was some improvement in the average technical efficiency scores. However, there was also marked inefficiency in many countries, which is likely to hamper their progress towards universal health coverage and other health system goals. In a context where health spending is too low to provide needed services, it is imperative to address the causes of technical inefficiency and produce more health for the money. Furthermore, low-performing health systems should learn from their relatively high-performing peers.

Access to Thoracic Aortic Care: Challenges and Opportunities in Universal Health Coverage Systems

Access to cardiovascular care requires geographical accessibility, infrastructural capacity, health care quality, financial affordability, and societal acceptability.1 In high-income countries with universal health coverage (UHC) models, such as Canada, geographic accessibility remains 1 of the most pressing barriers.2,3 Canada is the second-largest country by total area and fourth by land mass but 236th in terms of population density.4 The inherent regionalization of cardiac surgery in Canada results in cardiac surgical centres concentrating in larger cities, whereas those living outside large cities are scattered across vast distances.

The role of clinical reminder system to drug prescribing on patients of the National Health Insurance with ischemic stroke

Since 2014 Indonesia has entered the era of universal health coverage (UHC) and public health financing system managed by the Social Security Organizing Agency Law/SSOAL (Badan Penyelenggara Jaminan Sosial/BPJS) . In this system, a national formulary was used as the basis for prescribing drugs by clinicians. One effort for quality and cost control in UHC was to develop a clinical reminder system (CRS) to help prescriber set treatment options in accordance with the national formulary. The aim of this study was to measure the role of CRS to the compatibility of drug prescribing in patients with ischemic stroke in Bethesda Hospital Yogyakarta, Indonesia. This study was carried out using quasi-experimental with pre-test and post-test design. The subjects of this study were outpatient ischemic stroke and the National Health Insurance (NHI) participant, age &gt;18 years and had complete medication data. Prescribing data were compared between stroke patients treated at the hospital before and after implementation of CRS. The study was performed in 200 National Health Insurance (NHI) scheme outpatients with ischemic stroke. The groups consisted of 100 patients without CRS and 100 patients with CRS. The basic characteristics of both groups were similar. The results showed that after implementation of CRS, a significant improvement in the compliance of the neurologist prescribing medicine used to be available only in national formulary (RR: 1.02; 95% CI=1.00-1.04; p=0.015). Among others the most significant improvement was the prescription of antidyslipidemic using HMG-CoA medicine available in formulary. In conclusion, CRS can improve the compliance of prescribing with national formulary in stroke ischemic patients.

Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review.

BackgroundIndividuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD.MethodsIn this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.).ResultsOur searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD.ConclusionsThis systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.

A review of the long-term care policies under COVID-19 in Thailand’s aging society: implications for ASEAN countries

PurposeThis paper aims to explore the aging society situation, long-term care (LTC) policy preparation, COVID-19’s impact on older people, and post-pandemic preparations in Thailand and the implications for The Association of Southeast Asian Nations (ASEAN) countries.Design/methodology/approachOnline databases from international, national, academic agencies and SCOPUS database from January 2019 to July 2021 were utilized for analysis. Relevant literature and data were selected for review.FindingsThe evidence suggests that the proportion of the aging population is increasing due to declined fertility and rising life expectancy. Current and future demand for effective healthcare in ASEAN will be better achieved with policies like the Universal Health Coverage and Primary Health Care system. While some countries, specifically Thailand, are developing and expanding their LTC policies, some concerns regarding the active aging policy remain. Most ASEAN countries are using public domain for LTC policies. However, the COVID-19 pandemic has posed a major challenge in implementing LTC and affected the vulnerable aging population in many aspects, including social protection issues in Thailand.Originality/valueWith the support from international organizations, ASEAN countries have framed several policy strategies in response to the increasing aging population, such as providing more LTC in the community. The unexpected challenges from the COVID-19 pandemic compel policymakers to consider resource allocations and community-based services. On the positive side, as the pandemic has made the vulnerable group exposed, social protection issues have been brought to the forefront of the political debate and called for an appropriate policy response.

General Practitioners’ Attitudes toward Traditional Indonesian Herbal Medicine and Integrative Care in the Universal Health Coverage System

Implementation of the Universal Health Coverage (UHC) in Indonesia has created renewed momentum for integrating traditional Indonesian herbal medicine (TIHM) in healthcare delivery under the national health insurance program (NHI). At present, little is known about the attitudes of conventional healthcare practitioners towards the clinical use of TIHM. This study aimed to explore the attitudes of general practitioners (GPs) towards TIHM use in conventional care and their perception of the integration of TIHM in the NHI. A total of 30 GPs from 28 conventional health facilities were purposively selected to participate in the study. Both quantitative and qualitative data were collected through administered-questionnaire and interviews. The majority of participating GPs demonstrated a favourable view towards TIHM role in conventional care and the potential integration of TIHM under the NHI. Being used as an adjunct therapy in the conventional treatment of chronic diseases, including degenerative disease and metabolic syndrome, and in palliative care, seemed to be the most promising areas to emphasize TIHM role in conventional care in the anticipated integration. However, only a few GPs had formally prescribed TIHM to their patient. The barriers of TIHM use in their practice include knowledge gap, unclear regulatory procedure, unreliable provision of TIHM and exclusion of TIHM in the NHI. While the GPs accepted the idea of integrative care under the NHI, to achieve an institutional integration, their knowledge base in TIHM must be improved while also addressing regulation, development of TIHM&amp;rsquo;s formal list, and issues of safety of TIHM to ensure evidence-based practice.

Methods to collect communities' values and preferences about health systems coverage

Health systems do not have the capacity to finance all services. The impact of choosing one option or another is important in order to prioritize health resources. Citizen participation can help to set priorities or to select the interventions that will receive public funding. We reviewed the literature searching for articles that reported mechanisms to gather information about citizens' values or preferences about health system coverage. We identified 363 publications, 18 articles were analyzed in full, and 7 articles were included in the review. Three articles were European, two were from Australia and two from Latin America. The most commonly used mechanisms to gather information were interviews and surveys. We conclude that there is a limited number of articles with examples of tools to capture information about values and preferences in health decision processes. The main barrier observed was the lack of standardized processes to collect the values and preferences of the community.

Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study

SummaryBackgroundPopulation-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries.MethodsIn this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository.FindingsBetween 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2–66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0–9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9–6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1–3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7–2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians.InterpretationHealth outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health.FundingThe Bill & Melinda Gates Foundation.

Characteristics of Patients With Trigeminal Neuralgia Referred to the Indonesian National Brain Center Neurosurgery Clinic.

Trigeminal neuralgia (TN) is a debilitating neuropathic pain involving the fifth cranial nerve. There has been no study investigating the clinical and socioeconomical characteristics of patients with TN in Indonesia. A total of 100 patients were included in this study. Symptoms indicating a later stage of the illness, namely, involvement of all the trigeminal nerve branches, numbness, and concomitant persistent pain, were the common presentations found in our cohort. Only one TN diagnosis was made by a general practitioner (GP). None were immediately referred to a neurosurgeon following their diagnosis. Access to our clinic took as long as 4.7 ± 5.1 years (mean ± SD) from the onset. Older age was a significant predictor of an increased likelihood of not knowing their illness upon the referral (21.9%, p = 0.008). Upon their first presentation, 25.5% of patients had experienced drug-related side effects due to prolonged medication. Only 50% of patients were compensated by the universal health coverage (UHC) system. Seven patients spent ≥ 50 million rupiahs and eight patients had already lost their jobs. In conclusion, early contact with a neurosurgeon contributes to better management of TN, both for the patients and healthcare system in Indonesia. A refined understanding of TN nature is still needed in this country.

Thailand UHC in Action: Universal Access to Comprehensive COVID-19 Services by Thai and Non-Thai Population

Thailand achieved Universal Health Coverage (UHC) in 2002 through three main public health insurance schemes; the tax-financed Civil Servant Medical Benefit Scheme (CSMBS) covers public sector employees and dependants (7.1% of total population), payroll-tax financed Social Health Insurance (SHI) Scheme covers private sector employees (17.2%), and the tax-financed Universal Coverage Scheme (UCS) covers the remaining majority (75.7%) [1,2]. Registered migrant workers are covered by the SHI while voluntary premium-contribution migrant health insurance, managed by Ministry of Public Health (MOPH), covers undocumented migrants and their dependants. Hence, many unregistered migrant workers and their family members are not covered by any financial risk protection systems; services are paid for out-of-pocket [3]. Extensive geographical coverage of district health systems facilitates adequate and equitable access [4] with low levels of unmet needs [5]. The comprehensive benefit package [2] and free-at-point of services result in low and continually decreasing prevalence of catastrophic health spending [6] (6.7% in 1994 to 2.2% in 2017 [7]) and incidence of impoverishment (1.4% in 1996 to 0.4% in 2015 (using international poverty line of US$ 3.1 per capita per day)) [8]. This perspective analyses how Thailand has responded to the COVID-19 pandemic through the UHC lens, covering all Thai and non-Thai populations, including migrant workers, with a comprehensive set of COVID-19-related services for everyone--a key contributing factor to pandemic containment.

The current status of survivorship care provision at the state level: a Wisconsin-based assessment.

PurposeAs the number of cancer survivors grows, the responsibility for addressing their unique physical and emotional needs also increases. Survivorship care services vary by geography, health system, and insurance coverage. We aimed to understand the state of survivorship care services in Wisconsin’s cancer facilities.MethodsThe selection of cancer treatment facilities sought to provide a geographically representative sample. An adapted Patient-Centered Survivorship Care Index was comprised of questions regarding different aspects of survivorship practices. Areas of interest included disciplines incorporated, services provided, standards of care, and discussion of late-term effects, among others.ResultsOut of 90 sites invited, 40 responded (44.4%). Oncologists, physician assistants, and nurse practitioners were the most common follow-up care disciplines. Risk reduction services, dietary services, access to physical activity, and behavioral health specialist referral were described as standards of care in less than half of sites. All sites reported working with community partners, 92.5% of which worked with YMCA-related programs. Discussion of long-term effects was a standard of care for all sites. Effects such as emotional distress and health practice changes were frequently discussed with almost all patients, while sexual functioning and fertility were not.ConclusionsServices and specialties related to behavioral health, fertility/sexual health, and rehabilitation and physical activity varied between sites. Such services may be offered less often due to variable insurance coverage.Implications for Cancer SurvivorsPolicy solutions should be explored to increase insurance coverage and provision rates of necessary survivorship services to keep up with the projected increase in demand. Given imperfect and evolving measurement tools to assess needs for cancer survivorship care services, cancer survivors should feel empowered to voice when they have unmet needs and request referrals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01117-4.

Does universal health coverage reduce out-of-pocket expenditures for medical consultations for people living with HIV in Senegal? An exploratory cross-sectional study

ObjectivesIn Senegal, a national health coverage system named Couverture Medicale Universelle (CMU) has been under development since 2013; its impact on out-of-pocket (OOP) expenses for people living with HIV (PLHIV)...

Cancer screening at the level of state programs: review, recommendations and management

An overview of existing cancer screening programs, their organization system, and the main implementation parameters is presented. The methods of primary screening that have been shown to be effective in reducing mortality from certain cancers, as well as the reasons for the lack of screening programs in relation to some of them, are listed. The existing screening programs and their main characteristics are considered, and examples of using economic analysis to change screening programs are given. It is noted that in countries even with a large coverage, for example, in the United States and Germany, there is no single national register of screening, and the invitation system does not have a population-based nature. Although the large coverage and development of health systems in these countries allows for the positive effects of opportunistic screening, its effectiveness is lower than in countries with organized programs, and the costs are higher.

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

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.

Health Inequality Among Older Adults with Percutaneous Coronary Intervention and Universal Health Coverage in Japan.

This study aimed to comprehensively evaluate whether income affects long-term health outcomes for older patients who underwent percutaneous coronary intervention (PCI) provided by a universal health coverage system. Data were from the Latter Stage Elderly Healthcare Insurance database in Fukuoka Prefecture, Japan. A total of 5625 individuals aged ≥65 years who underwent PCI in 2014-2016 were included. Cox proportional hazards models were used to assess the association between income status and the incidence of health outcomes. With a median follow-up of 1095 days, 554 acute myocardial infarction (AMI) cases, 1075 stroke cases, 1690 repeat revascularization cases, and 1094 deaths were observed. Risk of all-cause mortality decreased significantly with increasing income level in both unadjusted and adjusted Cox regression models. Patients in the low-income level had a significantly higher rate of AMI (log-rank P = 0.003), stroke (log-rank P = 0.039), and all-cause mortality (log-rank P = 0.001) compared with patients in the high-income level. Observed rates for repeat revascularization also were high in the first year after PCI. In the Japanese universal health setting, low-income patients had a comparatively higher mortality risk after PCI. Poor long-term outcomes might be attributed to patients' baseline characteristics rather than treatment processes.

Predictors of the Use of Traditional Medicines in the Universal Health Coverage System in Indonesia

Background: Indonesia has committed to achieving Universal Health Coverage (UHC) and introduced national health insurance (JKN) to meet that commitment. Despite the increasing availability of healthcare services under the JKN scheme, traditional medicine (TM) continues to be a significant part of healthcare for Indonesians. In the context of the UHC system, this study aims to examine the predictors of TM use among urban and rural communities in Indonesia. &#x0D; &#x0D; Methods: A cross-sectional survey was conducted using a semi-structured questionnaire targeting urban and rural communities. A total of 926 households were randomly selected to participate in the survey. Multivariate logistic regression analysis was used to identify the significant predictors of TM use. &#x0D; &#x0D; Results: Multivariate analysis revealed the following variables to be predictive of TM use, namely, rural residence, being more educated, experiencing some health problem, demonstrating ethnomedical knowledge, having a favourable opinion about the safety and efficacy of TM and holistic orientation to health.&amp;nbsp; On the other hand, working in the formal sector was associated with lower odds of using TM compared to those who were employed in the informal sector. &#x0D; &#x0D; Conclusion: People&amp;rsquo;s experience, personal attributes, and attitude towards TM, rather than dissatisfaction with healthcare service, predicted the likelihood of using TM in the UHC system in Indonesia. This finding also implies the underutilisation of JKN services by the insured TM users living in rural areas. Considering the community&amp;rsquo;s strong preferences for TM, this paper argues that its inclusion in the JKN system may increase the utilisation of the JKN service.