Indonesian Healthcare System Research Articles

Footcare Intervention Delivered by Community Health Workers: A Modified Delphi Study.

Studies have shown that community health workers (CHWs) can effectively deliver footcare interventions (FCIs) as part of diabetes self-management education programmes in high-resource countries. However, more evidence is needed on implementing FCI in low-resource countries and more detailed information about the core components of FCI provided by CHWs. This study aims to refine the core components of the footcare intervention to be delivered by CHWs (FIne-CHWs) for T2DM patients and to analyse Delphi panel members' opinions and perceptions regarding the core components of FIne-CHWs. Triangulation data from previous steps of data collection (scoping and mapping review combined with interview data) identified 42 statements representing the core components of FIne-CHWs. After two rounds of a Delphi exercise involving 22 panel members, experts in diabetes from all over Indonesia, a consensus agreement was reached on 41 out of 42 statements of the core components of FIne-CHWs. Free-text responses to the Delphi survey were analysed using thematic analysis. One overarching theme emerged: CHWs "are only volunteers." This then was discussed in three themes, namely CHWs deliver footcare education for all people with diabetes, remuneration and incentives, and flexibility of community FCI. This study determined the core components of FIne-CHWs and also identified that the position of CHWs within the Indonesian healthcare system could impact the implementation of the FIne-CHWs programme.

Overview of Indonesian Community Pharmacy: Understanding Practice Changes

<p><span lang="EN-US">Community pharmacy practice in Indonesia has shifted to a patient-centered model, offering a </span><span lang="EN-US">range</span><span lang="EN-US"> of services that include treatment advice, chronic disease management, and public health promotion. This shift benefits consumers who visit community pharmacies as their initial healthcare point. The Indonesian healthcare system, a mix of public and private providers, is governed by a decentralized structure, fostering significant investment in private healthcare despite access limitations due to financial capacity. Medicines distribution, managed by the District Health Office, ensures supply to primary healthcare facilities, with community pharmacies regulated by the Ministry of Health and the Indonesian National Food and Drug Agency. Despite stringent regulations mandating comprehensive services, most pharmacists are not remunerated for their services. Pharmacy staff, including formally qualified pharmacists and pharmacy technicians, are registered professionals, with recent trends indicating a shift towards employing pharmacy technicians to enable pharmacists to focus on clinical roles. Economic factors and innovative service delivery modes, such as telepharmacy and online purchasing, are expected to influence future practices, enhancing the pharmacist's role in chronic disease management and other health conditions. The evolving community pharmacy practice in Indonesia reflects broader changes in the healthcare system and professional roles, with continued progression anticipated.</span></p>

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings.

Human albumin (HA) is an effective adjuvant treatment for patients with cirrhosis developing spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and ascites requiring large-volume paracentesis (LVP). However, cost remains a barrier to use, particularly in resource-limited settings. This study aims to assess the cost-effectiveness of HA in patients with cirrhosis with SBP, HRS or ascites requiring LVP in the Indonesian healthcare system as a representative of a resource-limited setting. Three decision-tree models were developed to assess the cost-effectiveness of (1) antibiotics and HA versus antibiotics alone in patients with SBP, (2) terlipressin and HA versus terlipressin alone in patients with HRS, and (3) LVP and HA versus LVP and gelatine for patients with ascites. Clinical utility and economic inputs were pooled from the available literature. Time horizon was 3 months. Outcomes were expressed as incremental cost-effectiveness ratios (ICER) reported as 2021 IDR per quality-adjusted life year (QALY) (exchange rate June 30, 2021: 1 EUR = 17,245 IDR). Willingness-to-pay thresholds considered were: three times the GDP per capita (199,355,561 IDR/QALY; 11,560 EUR/QALY) and one time the GDP per capita (66,451,854 IDR/QALY; 3853 EUR/QALY). The ICER for antibiotics and HA (versus antibiotics alone) for SBP was 80,562,652 IDR per QALY gained (4672 EUR/QALY). The ICER for terlipressin and HA (versus terlipressin) for HRS was 23,085,004 IDR per QALY gained (1339 EUR/QALY). The ICER for LVP and HA versus LVP and gelatine was 24,569,827 IDR per QALY gained (1425 EUR/QALY). Adjunctive HA may be a cost-effective treatment for SBP, HRS and LVP in resource-limited settings.

Evaluating the cost-effectiveness of diabetic foot ulcer management by wound care specialists in Indonesia.

Diabetic foot ulcers affect quality of life and economically burden patients and the Indonesian healthcare system. The comparative cost-effectiveness of wound care specialists in private practices (e.g., wound clinics) and wound care nurses in national hospitals remains unknown. Thus, we used a decision tree to compare the cost and healing rates for patients after 12 weeks of wound care. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Among 89 participants (42 in the national hospital and 47 in the private practice), no significant differences were observed between the two groups in terms of sex, age, education level, smoking status, duration of diabetes, Wagner wound classification, glycated haemoglobin levels, neuropathy status, ankle-brachial index, baseline characteristics, quality of life, DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) score and wound location (p > 0.05). However, significant differences were observed for days from first visit/assessment until complete healing, mean quality of life (p ≤ 0.001) and wound size (p = 0.047). Wound care specialists in private practices had a significantly lower cost of 2,804,423.3 Indonesian rupiah compared to 6,483,493.4 Indonesian rupiah for wound care nurses in national hospitals. The incremental cost-effectiveness ratio was -165,723.9. Therefore, wound care specialists in private practices are more cost-effective for managing diabetic foot ulcers. Probability sensitivity analysis confirmed that 80%-90% of the scenarios were cost-effective. These findings may inform healthcare resource allocation in Indonesia. Additionally, evidence-based cost-effectiveness measures were strengthened in private practices and national hospitals.

Indonesian Euphorbiaceae: Ethnobotanical Survey, In Vitro Antibacterial, Antitumour Screening and Phytochemical Analysis of Euphorbia atoto.

Indonesia is among the countries with the most significant biodiversity globally. Jamu, the traditional medicine of Indonesia, predominantly uses herbal materials and is an integral component of the Indonesian healthcare system. The present study reviewed the ethnobotanical data of seven Indonesian Euphorbiaceae species, namely Euphorbia atoto, E. hypericifolia, Homalanthus giganteus, Macaranga tanarius, Mallotus mollissimus, M. rufidulus, and Shirakiopsis indica, based on the RISTOJA database and other literature sources. An antimicrobial screening of the plant extracts was performed in 15 microorganisms using the disk diffusion and broth microdilution methods, and the antiproliferative effects were examined in drug-sensitive Colo 205 and resistant Colo 320 cells by the MTT assay. The antimicrobial testing showed a high potency of M. tanarius, H. giganteus, M. rufidulus, S. indica, and E. atoto extracts (MIC = 12.5-500 µg/mL) against different bacteria. In the antitumour screening, remarkable activities (IC50 0.23-2.60 µg/mL) were demonstrated for the extracts of H. giganteus, M. rufidulus, S. indica, and E. atoto against Colo 205 cells. The n-hexane extract of E. atoto, with an IC50 value of 0.24 ± 0.06 µg/mL (Colo 205), was subjected to multistep chromatographic separation, and 24-methylene-cycloartan-3β-ol, jolkinolide E, tetra-tert-butyl-diphenyl ether, α-tocopherol, and β-sitosterol were isolated.

REBT Integration in Public and Private Outpatient Settings during COVID-19 Pandemic: Perspectives from Indonesia

This quasi-experimental study aimed to investigate how rational emotive behavior therapy (REBT) works in Indonesian outpatient settings, especially in the context of the COVID-19 pandemic. This study evaluated depression, anxiety, and sleep among 60 Atma Jaya Hospital patients (public and private) using several assessment tools (PHQ-9, GAD-7, and PSQI). The majority of participants were under 40 (53.3%), female (58.3%), married (56.6%), and working formally (65%), with either high school or diploma/bachelor’s level education (86.6%). After six REBT therapy sessions, significant improvements were evident in anxiety, depression, and sleep quality scores (p < 0.001). Participants showed improvements in anxiety and depression during the third and sixth sessions; and in sleep quality during the sixth session. These findings suggest that REBT-based interventions are effective in public and private outpatient settings, highlighting the importance of psychotherapy and cross-division collaboration in the Indonesian healthcare system.

Population-based study on coverage and healthcare processes for cancer during implementation of national healthcare insurance in Indonesia.

A national healthcare insurance has been implemented in Indonesia since 2014. Although cancer care currently represents a smaller part of the healthcare support, the demographic development will lead to a rapid growth of the population within age groups at cancer risk. This requires strategic and developmental planning of cancer care resources. Based on data of the national healthcare insurance, current cancer care processes and their determinants were evaluated. Nationwide reimbursement data as well as demographic, economic and healthcare infrastructure data were used for the study. Poor and underserved population was stratified according to the national classification system. Availability of healthcare resources was evaluated at provincial level. Cancer care usage was analysed applying descriptive and multivariate statistical approaches (regression, cluster analysis, tree classification). Cancer care was provided in primary care (PHC) for 2.6/1000 and advanced care (AHC) for 4.8/1000 participants within the family-based membership structure. Regression analysis revealed human resource availability in rural/remote areas a determinant for cancer PHC. Cancer care in AHC was determined by PHC provided by general practitioners (GP), availability of AHC infrastructure (Class A & B hospital beds) and treatment migration between provinces. Tree classification confirmed predominant roles of GP, AHC infrastructure and referral between cancer care provider levels. Cancer care will gain much higher importance for the Indonesian healthcare system within the next decade. Infrastructure, human resources, and process development should avoid rising overload of cancer care delivery by targeting reduction of treatment migration (availability of GPs in rural/remote provinces), improvement of referral systems (effective clinical selection processes and back-referral) and AHC cancer care structures (regional distribution of Class A & B hospitals). This project was supported by grants from Centre for Research, Publication, and Community Development Muhammadiyah University of Yogyakarta (SW, ID), and data provision by BPJS Indonesia.

Estimating the Health Effects of Expansions in Health Expenditure in Indonesia: A Dynamic Panel Data Approach.

The marginal productivity of a country's healthcare system refers to the health gains produced per unit change in the level of spending. In budget-constrained settings, this metric reflects the opportunity cost, in terms of health gains forgone, of committing additional or existing resources to alternative uses within the healthcare system. It can therefore assist in evidence-based decisions on whether different interventions represent good value for money. The aim of this paper was to estimate the marginal productivity of the Indonesian healthcare system using subnational data, and to use this to inform health opportunity costs in the country. We define a dynamic health production function to model the stream of effects of current and prior public health spending decisions on population under-five mortality. To estimate the model, we use data from the 33 Indonesian provinces for the 2004-2012 period. The estimated elasticity is then translated into gains in terms of cost per DALY (disability-adjusted life-year) averted. We use dynamic panel data methods to address potential endogeneity issues in the model. Our base-case estimates suggest that a 1% expansion in the level of health spending reduces under-five mortality by 0.38% (95% CI 0.00-0.76), which translates into a cost of averting one DALY of $235 (2019 US$). With Indonesia aiming for universal health coverage, our results support these efforts by highlighting the associated benefits resulting from increases in public health expenditure and have the potential to inform the decision-making process about a suitable locally relevant cost-effectiveness threshold.

Challenges on tuberculosis care in health care facilities during COVID-19 pandemic: Indonesian perspective.

Indonesia is among the top three countries globally with the highest tuberculosis burden. During the past decades, Indonesian health authorities have struggled to improve tuberculosis care quality in health care facilities by optimizing the regulation and strengthening the private sector contributions. The coronavirus disease 2019 (COVID-19) pandemic has hardly affected the Indonesian health care system, including the National Tuberculosis Control Program. While the end of the COVID-19 pandemic in Indonesia is uncertain, the measure to control tuberculosis must not be weakened. Early identification and measurement of the problem size are essential to decide the most appropriate approach to maintain the sustainability of National Tuberculosis Control Program, particularly in health care facilities during the COVID-19 pandemic. This article points out the possible threats to the sustainability of TB care in Indonesia during the COVID-19 pandemic, including some approaches to overcome those problems.

Emergency services utilization in Jakarta (Indonesia): a cross-sectional study of patients attending hospital emergency departments

BackgroundPre-hospital and emergency services in Indonesia are still developing. Despite recent improvements in the Indonesian healthcare system, issues with the provision of pre-hospital and emergency services persist. The demand for pre-hospital and emergency services has not been the subject of previous research and, therefore, has not been fully understood. Our research explored the utilization of emergency medical services by patients attending hospital emergency departments in Jakarta, Indonesia.MethodsThe study used a cross-sectional survey design involving five general hospitals (four government-funded and one private). Each patient’s demographic profile, medical conditions, time to treatment, and mode of transport to reach the hospital were analysed using descriptive statistics.ResultsA total of 1964 (62%) patients were surveyed. The median age of patients was 44 years with an interquartile range (IQR) of 26 to 58 years. Life-threatening conditions such as trauma and cardiovascular disease were found in 8.6 and 6.6% of patients, respectively. The majority of patients with trauma travelled to the hospital using a motorcycle or car (59.8%). An ambulance was used by only 9.3% of all patients and 38% of patients reported that they were not aware of the availability of ambulances. Ambulance response time was longer as compared to other modes of transportation (median: 24 minutes and IQR: 12 to 54 minutes). The longest time to treatment was experienced by patients with neurological disease, with a median time of 120 minutes (IQR: 78 to 270 minutes). Patients who used ambulances incurred higher costs as compared to those patients who did not use ambulances.ConclusionThe low utilization of emergency ambulances in Jakarta could be contributed to patients’ lack of awareness of medical symptoms and the existence of ambulance services, and patients’ disinclination to use ambulances due to high costs and long response times. The emergency ambulance services can be improved by increasing population awareness on symptoms that warrant the use of ambulances and reducing the cost burden related to ambulance use.

Indonesian hospital’s preparedness for handling COVID-19 in the early onset of an outbreak: A qualitative study of nurse managers

BackgroundHospitals must be well-prepared to respond to pandemics. Hospital preparedness is critical to ensure optimal health service functioning and care delivery to reduce the transmission of COVID-19. Nurse managers play critical roles and provide expert advice on hospital preparedness models, to facilitate the delivery of safe and effective care, within the pandemic context. AimTo explore nurse managers' perspectives of hospital preparedness to handle the COVID-19 pandemic in its early phase. DesignDescriptive qualitative study. MethodsNurse managers were recruited from two public hospitals designated for handling COVID-19, in East Java of Indonesia, using purposive sampling. Semi-structured interviews were conducted via phone and video conference. Data were analysed using the content analysis. ResultsA total of nine nurse managers participated and were included in analyses. Three main categories were identified. These were (1) operational policy, (2) infrastructure arrangement, and (3) healthcare personnel management. ConclusionsThe Indonesian healthcare system has made responsive adjustments to handle COVID-19 by increasing the flexibility and adaptability of institutional physical structures, services, and human resources on the early phase of the COVID-19 pandemic.

Who should care? Exploring the views and experiences of individuals in negotiating solutions for health security

PurposeThe Indonesian healthcare system has been reformed in tune with economic and political changes. The reform was pursued by encouraging growing reliance on individual contributions. Consolidating citizens' support has become increasingly important for the long-term sustainability of the programme. This study explores individual views and experiences in negotiating solutions for health security under the situation where pre-industrial modes of informal network remain intact, while private healthcare continues to be in demand by population segments targeted by the system.Design/methodology/approachIndividual attitudes toward the current healthcare system were explored using online interviews (N = 75) in the cities of Jakarta and Yogyakarta, Indonesia. The qualitative exploratory approach resorted to personal views on the importance of the state, family and market in health risk management. Perceptions on who should be responsible for healthcare, and the political legitimacy of the welfare-state approach to healthcare were also observed. A thematic coding strategy was used for the data analysis.FindingsThose interviewed value and support the formal system (either state and market), yet place reliance on informal support (family and relatives). Intertwining views of religious teaching, filial piety, moral obligation were the most common reasons for individuals to support such dual welfare systems. The findings reflect the common attitudes toward welfare in the context of changing realities of individualised society at the early stage.Originality/valueThis article represents a valuable contribution at the empirical level because it provides an assessment of individuals' attitudes toward Indonesia's recent health arrangements. Such individuals are those belonging to the targeted population of the contributory system. This study also offers an alternative framework for understanding the nature of the healthcare regime generated from the perspectives of individuals.

The Capacity of the Indonesian Healthcare System to Respond to COVID-19.

The Indonesian Government has issued various policies to fight Coronavirus Disease (COVID-19). However, cases have continued to fluctuate over a year into the pandemic. There is a need to assess the country's healthcare system's capacity to absorb and accommodate the varying healthcare demands. We reviewed the current capacity of Indonesia's healthcare system to respond to COVID-19 based on the four essential elements of surge capacity: staff, stuff, structure, and system. Currently available medical staffs are insufficient to deal with potentially increasing demands as the pandemic highlighted the human resources challenges the healthcare system has been struggling with. The pandemic has exposed the fragility of medical supply chains. Surges in the number of patients requiring hospitalization have led to depleted medical supplies. The existing healthcare infrastructure is still inadequate to deal with the rise of COVID-19 cases, which has also exposed the limited capacity of the healthcare infrastructure to manage medical waste. The COVID-19 pandemic has further exposed the weakness of the patient referral system and the limited capacity of the healthcare system to deliver essential health services under prolonged emergencies. The Indonesian Government needs to ramp up the country's healthcare capacity. A wide range of strategies has been proposed to address those mounting challenges. Notwithstanding, the challenges of increasing healthcare capacity highlight that such efforts could represent only one part of the pandemic response equation. Effective pandemic response ultimately requires governments' commitment to increase healthcare capacity and flatten the curve concurrently.

Economic Evaluation of Adding Bevacizumab to Chemotherapy for Metastatic Colorectal Cancer (mCRC) Patients in Indonesia.

Objective:Since 2016, bevacizumab has been widely used to treat metastatic colorectal cancer (mCRC) in Indonesia. Nevertheless, the high cost of bevacizumab has raised the question of whether the therapy is considered cost-effective and should be included in the national health insurance system. This study aimed to assess the cost-effectiveness of bevacizumab plus chemotherapy versus chemotherapy alone for the treatment of mCRC patients.Methods:A Markov model was applied using the perspective of the Indonesian healthcare system to assess cost-effectiveness. The health outcomes were expressed in terms of quality-adjusted life years (QALY) using the validated EuroQoL-5D-5L instrument. Data for medical costs were collected from hospital billings in four hospitals located in three different cities in Indonesia. Meanwhile, data for utility were obtained from interviewing 90 patients who came to the hospital. We compared those mCRC patients who received chemotherapy alone either with FOLFOX or FOLFIRI, versus patients who received the addition of bevacizumab. Results:With the perspective of societal, the incremental cost-effectiveness ratio (ICER) of adding bevacizumab was USD 49,312 per QALY gained using secondary data and USD 28,446 per QALY using real world data. Conclusion:Using either a healthcare or societal perspective, the addition of bevacizumab for mCRC treatment was considered not cost-effective.

Community Health Center Efficiency. The Impact of Organization Design and Local Context: The Case of Indonesia.

The decentralization of the Indonesian healthcare system, launched in the year 2000, allowed the authorities of local community health centers (CHCs) to tailor their services to the needs of their clients. Many observers see this as an opportunity to increase CHC efficiency. Building on the Context Design Performance Framework, this paper assesses the extent to which efficiency variations between CHCs can be explained by the degree of fit between their organizational design characteristics and aspects of the communities in which they are embedded. Data envelopment analysis (DEA) was applied to construct a measure of CHC efficiency for a sample of 598 CHCs in 2011, drawn from a publicly available Ministry of Health (MoH) dataset. Tobit regression analysis was applied to assess the impact of organization design and community characteristics and their interplay on efficiency. Large variations in CHC efficiency were discovered, suggesting that not all CHCs are equally capable of finding the optimal design to operate most efficiently. A significant inverted U-shape relationship was found for the organization design-efficiency link: efficiency is highest for CHCs with 1-2 horizontal units and decreases for CHCs exceeding or not reaching this number. No significant association was found between community characteristics (proportion of poor people, remote location of CHC) and CHC efficiency. Organizational design matters for CHC efficiency, but no evidence was found for the hypothesis that a better fit between community characteristics and CHC design increases efficiency. A potential reason for this might be that CHC management's main design challenge is how to cope with the scarce availability of well-trained health personnel.

Cost calculation of dental service at Pratama Clinic using Activity-based Costing method in Padang, West Sumatera, Indonesia

Aim: Indonesian health-care system evolution is attributed to billing and insurance of the health service, especially on basic dental service through capitation payment. Administrative cost estimation is important to equalize the allocation of health insurance expenditure spread over the dental clinic in Indonesia. The aim of this study was to calculate unit cost value at urban and suburban dental services at Pratama Clinic at Padang, West Sumatera, Indonesia. Materials and Methods: Two dental services at Pratama clinics at urban and suburban areas selected by random sampling. Unit cost patient day was applied by Activity-Based Costing method. Statistical analysis: The cost was calculated by using computerized Microsoft Excel analysis. Results: Suburban dental service Pratama Clinic has higher activity driver value than urban counterpart, but there is no significant difference between resource driver at urban and suburban dental service Pratama Clinic. The unit cost calculation of dental service at urban and suburban Pratama Clinic is US$5.26 and US$5.36, respectively. Conclusion: These findings outline that unit cost value at suburban is higher than urban dental service Pratama Clinic. So, these usefull to provide the basic information regarding the government to implement the equal and efficient health-care expenditure, particularly on each area in Indonesia.

Preventing Fraud and Deficit Through The Optimization of Health Insurance In Indonesia

BPJS Kesehatan (Indonesian Health Insurance System) has been experiencing a severe problem for many years that BPJS Kesehatan has been suffering a huge deficit. That situation is getting worse and taking a negative impact on hospitals, medical practitioners, and patients itself. The more severe problem felt by a patient who needs special treatment and medication. Due to the deficit of the BPJS Kesehatan budget, some hospitals owe some money to the pharmaceutical company to buy some medicines. However, they cannot buy the medication because they have no budget. This study is to explain and compare with the National Health Insurance System in Taiwan to resolve the problems within BPJS Kesehatan in Indonesia, notably on the supervisory system between 2 (two) countries. The method used in this study is the Systematic Literature Review (SLR) method with qualitative approval from secondary data in approving, reviewing, evaluating, and research supporting all available research in 2015-2020. Then obtained the appropriate literature received seven literature. the factors that make BPJS Kesehatan deficit is because of the small premium, bad management, and fraud. A lot of fraud obtained within BPJS Kesehatan. The fundamental reason why fraud still exists is the weak of the supervisory system. The author will explain that problem of BPJS Kesehatan actually can be tackled by transplanting the healthcare system in Taiwan to the Indonesian healthcare system on the supervisory system. How to Cite this Article Pubmed Style Sunarti S, Ghozali M, Haris F, Rahman FF, Rahman RA, Ghozali . Fraud and Deficit Through The Optimization of Health Insurance In SRP. 2020; 11(7): 228-231. doi:10.31838/srp.2020.7.36 Web Style Sunarti S, Ghozali M, Haris F, Rahman FF, Rahman RA, Ghozali . Fraud and Deficit Through The Optimization of Health Insurance In http://www.sysrevpharm.org/?mno=126862 [Access: March 29, 2021]. doi:10.31838/srp.2020.7.36 AMA (American Medical Association) Style Sunarti S, Ghozali M, Haris F, Rahman FF, Rahman RA, Ghozali . Fraud and Deficit Through The Optimization of Health Insurance In SRP. 2020; 11(7): 228-231. doi:10.31838/srp.2020.7.36 Vancouver/ICMJE Style Sunarti S, Ghozali M, Haris F, Rahman FF, Rahman RA, Ghozali . Fraud and Deficit Through The Optimization of Health Insurance In SRP. (2020), [cited March 29, 2021]; 11(7): 228-231. doi:10.31838/srp.2020.7.36 Harvard Style Sunarti, S., Ghozali, . M., Haris, . F., Rahman, . F. F., Rahman, . R. A. & Ghozali, . (2020) Fraud and Deficit Through The Optimization of Health Insurance In SRP, 11 (7), 228-231. doi:10.31838/srp.2020.7.36 Turabian Style Sunarti, Sri, MT Ghozali, Fahni Haris, Ferry Fadzlul Rahman, Rofi Aulia Rahman, and Ghozali. 2020. Fraud and Deficit Through The Optimization of Health Insurance In Systematic Reviews in Pharmacy, 11 (7), 228-231. doi:10.31838/srp.2020.7.36 Chicago Style Sunarti, Sri, MT Ghozali, Fahni Haris, Ferry Fadzlul Rahman, Rofi Aulia Rahman, and Ghozali. Preventing Fraud and Deficit Through The Optimization of Health Insurance In Indonesia. Systematic Reviews in Pharmacy 11 (2020), 228-231. doi:10.31838/srp.2020.7.36 MLA (The Modern Language Association) Style Sunarti, Sri, MT Ghozali, Fahni Haris, Ferry Fadzlul Rahman, Rofi Aulia Rahman, and Ghozali. Preventing Fraud and Deficit Through The Optimization of Health Insurance In Indonesia. Systematic Reviews in Pharmacy 11.7 (2020), 228-231. Print. doi:10.31838/srp.2020.7.36 APA (American Psychological Association) Style Sunarti, S., Ghozali, . M., Haris, . F., Rahman, . F. F., Rahman, . R. A. & Ghozali, . (2020) Fraud and Deficit Through The Optimization of Health Insurance In Systematic Reviews in Pharmacy, 11 (7), 228-231. doi:10.31838/srp.2020.7.36

Evaluation of a point-of-care ultrasound curriculum taught by medical students for physicians, nurses, and midwives in rural Indonesia.

In the Indonesian health-care system, nurses and midwives often serve as the primary health-care providers due to physician shortages. Seeking to address the need for medical care in resource-limited environments, some have advocated for portable equipment in the hands of health-care providers. We hypothesized that medical students are able to effectively teach point-of-care ultrasound (POCUS) to physicians, nurses, and midwives in rural Indonesia. We conducted a prospective, observational study using health-care practitioners from a clinic and accredited school for nursing and midwifery in Mojokerto, East Java, Indonesia. Enrolled practitioners took part in a 4-week POCUS course followed by postinstructional testing. A total of 55 health-care practitioners completed the course. This included 19 physicians, 13 nurses, and 19 midwives. Of the 55 clinicians, 43 (72%) passed the course and 12 (28%) failed. Physicians, nurses, and midwives in rural Indonesia showed significant acquisition of ultrasound (US) knowledge and skills following a 4-week US course. Following training, all three groups displayed skills in practical US use during a postcourse practical examination. This is one of the first studies to assess the efficacy of medical students teaching POCUS to midwives and nurses.

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.

Narrative Navigation: HIV and (Good) Care in Aceh, Indonesia

In this article, I elaborate the concept of narrative navigation to analyze the subjective and intersubjective ways in which people struggle through experiences of illness by constructing multiple, ambiguous and non-linear narratives that may continuously change, as they reposition themselves within changing circumstances. Drawing on ethnographic material on HIV care in Aceh, Indonesia, I show how subjunctivity and open-endedness are crucial narrative ways in which people living with HIV, their relatives, medical doctors and support group workers adjust to possibilities and limitations of care over time, thereby continuously negotiating what good care may be. Unfolding within a changing Indonesian healthcare system, their narrative navigations reveal caregiving to be a complex and contradictory process, thereby problematizing boundaries between good care and neglect.