Implementation Of National Health Insurance Research Articles

NATIONAL HEALTH INSURANCE AND CATASTROPHIC HEALTH EXPENDITURE: A COMPLEMENTARY LOG-LOG APPROACH ON YOGYAKARTA’S INCIDENCE 2022

National Health Insurance (JKN) aims to provide health care benefits to meet people's basic health needs. However, despite the high JKN coverage in D.I.Yogyakarta Province, catastrophic health expenditure events remain high. The study examines the implementation of National Health Insurance (JKN) in D.I.Yogyakarta Province and its effectiveness in reducing devastating health expenditures in 2022. Using the Complementary Log-log approach on the 2022 National Social and Economic Survey data, the research findings reveal that the implementation of JKN has been successful, and the ownership of JKN positively affects the reduction of catastrophic health expenditure. The study also shows that the education level of household members and household size have positive effects on reducing the incidence of catastrophic health expenditures. However, the presence of babies or the elderly, household economic status, and inpatient status could increase the risk of having catastrophic health expenditures. The study highlights the need for attention to be given to implementing JKN in D.I.Yogyakarta Province and other variables to achieve universal health coverage and reduce catastrophic health expenditure.

Role of local government officers in the implementation of national health insurance for poor peoples

This study explains the performance of the local government in implementing the Indonesian national health insurance policy model for the poor. This study used qualitative research methods. In addition, in-depth interviews, observations, and document studies were used for data collection. The data analysis consisted of data reduction, display, conclusion drawing, and verification. The study results revealed the performance patterns of local government officials, such as local government officials' capabilities, bureaucratic culture, political interests, principles of universality, and financing of health coverage. Implementing a national health insurance policy for the poor people in Bandung City, West Java, Indonesia, has implications for a broader dimension, such as political, legal, economic, social, and cultural research, which has implications for the development of health resources, improvement of the population administration system, financing and quality, and cost control.

The relationship of health insurance ownership with the utilization of health services in coastal rural and urban communities (Case Study: Kapoiala Health Centre, Soropia and Nambo Health Centre) Southeast Sulawesi Province, Indonesia, 2023

Background: Health is a human right and every citizen has the right to receive health services. Therefore, the Indonesian government must guarantee that every resident gets quality health services through the implementation of national health insurance as a global commitment for every country to implement universal health coverage. In Indonesia, the number of Social Security Administrator participants reached 248.77 million people or the equivalent of 90.73% of the entire population of Indonesia which was recorded at 274.20 million people, while in Southeast Sulawesi the number of Social Security Administrator participants was 8,071,716 people. Method: The type of research used is descriptive quantitative with a cross-sectional study approach, namely looking for the relationship between ownership of health insurance and utilization of rural and urban coastal community health services (case studies: Kapoiala Health Center, Soropia Health Center and Nambo Health Center) The number of samples in this research was 1,040 people consisting of 535 urban coastal respondents and 505 rural coastal respondents. The sampling techniques are purposive sampling and accidental sampling. The analysis used in this research is chi-square analysis. Results: The results of the study show that there is a significant relationship between ownership of health insurance and utilization of health services with a ρvalue (0.037) < 0.05 in the working areas of the Kapoiala Health Center, Soropia Health Center and Nambo Health Center, Southeast Sulawesi Province, Indonesia. Conclusion: There is a significant relationship between ownership of health insurance and utilization of rural and urban coastal community health services in the working areas of Kapoiala Health Center, Soropia Health Center and Nambo Health Center, Southeast Sulawesi Province. Therefore, it is necessary to increase the acceleration of social security administrator membership to reach 100% UHC through regional government and central government schemes. social security administrator needs to increase socialization with various media that are more effective in increasing community participation in becoming social security administrator participants.

South African healthcare reforms towards universal healthcare – where to next?

The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

BackgroundThe National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS).MethodsThis is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis.ResultsWe observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001).ConclusionsThis study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.

The views of family physicians on National Health Insurance in Gauteng Province, South Africa.

Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution:This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.

Strengthening Competence of Hospital Data Management to Control The Quality Of Cesarean Section Rate in Banten Province, Indonesia

Cesarean delivery dramatically increased worldwide, including in Indonesia, especially after the implementation of National Health Insurance, with a steady increase of 2-3% every year. This study aims to evaluate the effect of guidance in implementing the Robson Classification in cesarean section quality control in hospitals. Three hospitals in Banten were enrolled in this study: one public hospital and two private hospitals. Each hospital’s staff were given online and offline training on quality control of cesarean section, managing cesarean section data, data entry, data analysis and presentation using Robson Classification. Participant’s knowledge and attitude were collected before and after intervention using a standardized questionnaire. The results showed that the intervention improved many aspects of the workflow and knowledge of the hospital staff regarding cesarean section. There was an increase of up to 77.7% in digital data management, a 23.6% increase in routine meeting activities, and a 29.5% increase in cesarean quality control. The Robson classification system was implemented successfully, increasing the staff's ability to identify the groups needing cesarean sections more effectively. Guidance on data management for cesarean section increases the ability of the three hospitals in Banten to control cesarean section using Robson's Classification. Guidance methods can be used to assist other hospitals in controlling cesarean section.

The clinicians’ perspective on the National Health Insurance implementation in Indonesia: A study in a government hospital

ABSTRACT Effective healthcare system reforms in hospital settings depend on clinicians’ supportive responses, given their crucial role in decision-making and resource allocation. This qualitative research, conducted in a government hospital in Indonesia, explores clinicians’ reactions to challenges arising from National Health Insurance (NHI) implementation and their responses to hospital initiatives addressing NHI-related issues. Under NHI, cost control measures have constrained clinicians’ clinical autonomy, resource utilization, and, in many cases, their income. However, clinicians’ perspectives on NHI have evolved from initial scepticism and resistance to eventual adaptation and acceptance, influenced by the alignment of NHI with their professional values and goals. The responsiveness and adeptness of hospital management in balancing NHI standards with professional values have been pivotal in facilitating this transformation. The management’s effectiveness in applying mutually advantageous initiatives, harmonizing with the values and objectives of healthcare reform, healthcare professionals, and healthcare organizations, has been instrumental in the successful reform implementation. This study underscores the importance of a collaborative approach between clinicians and hospital management in navigating the complexities of healthcare reform. This research contributes valuable insights to the ongoing discourse on healthcare reform, emphasizing the interconnectedness of actors, their values, and organizational responses in shaping the outcomes of reform efforts.

Factors associated with compliance payments patient social assurance administrative agency of health independent participants in the hospital Kendari city southeast Sulawesi province Indonesia, 2023

Background: Health is a human right that must be fulfilled by every country. Therefore, the Indonesian government guarantees quality health services through the implementation of national health insurance as a global commitment for every country to implement universal health coverage. In Indonesia, the number of participants in the health social assurance administration agency reached 248.77 million people or the equivalent of 90.73% of the entire population of Indonesia which was recorded at 274.20 million people. Southeast Sulawesi has a total of 8,071,716 health social assurance administration agency participants, while in Kendari City the number of participants from the health social security administration body reached 67,375 as of August 2023. However, health social assurance administration agency membership is not followed by the level of compliance of health social assurance administration agency participants in paying contributions. Method: The type of research used is descriptive quantitative with a cross sectional study approach. The total sample was 505 respondents with sampling methods, namely accidental sampling and purposive sampling. The independent variables are knowledge and sanctions, while the dependent variable is compliance with paying contributions. Data analysis uses bivariate analysis with the unit of analysis, namely the chi-square test with SPSS. Result: The results of the research show that there is a significant relationship between knowledge and compliance with paying health social assurance administration agency. The results of statistical tests using the chi-square test obtained a p-value = 0.000 &lt; 0.05. Meanwhile, there is no relationship between sanctions and compliance with paying health social assurance administration agency. The results of statistical tests using the chi-square test obtained a p-value = 0.541 &gt; 0.05. Conclusion: There is a relationship between knowledge and compliance with paying health social assurance administration agency independent participant and there is no relationship between sanctions and compliance with paying health social assurance administration agency independent participant in hospitals throughout Kendari City. Therefore, health social assurance administration agency needs to collaborate with all stakeholders involved to increase socialization so that health social assurance administration agency independent participant membership achievements are directly proportional to compliance with paying contributions, because this can indirectly affect health services.

Potential fraud and its’ prevention in the implementation of national health insurance at Dadi Regional Hospita

The National Health Insurance program started running in Indonesia on January 1, 2014. Along with the increasing number of National Health Insurance participants and health facilities, more criticism has emerged from various parties, including from National Health Insurance providers regarding the alleged fraud. Fraud can have a negative effect on finances, the standard of medical care, and the perpetrator's reputation. This study's goal was to assess the likelihood that fraud may occur at Dadi Regional Hospital in Makassar, Indonesia. The study also explored the procedures and policies in place for preventing the fraud. This qualitative study employed phenomenological design. The results of the study show that there is a fraud prevention system at Dadi Regional Hospital in the form of policy and guideline formulation, a culture of prevention, implementation of quality control, and cost control. Even though they already have a prevention system in place, there is still some lack of information being disseminated about the fraud prevention team established. There are still frequent discrepancies between the diagnosis code input in the National Health Insurance system and the patient's diagnosis Hence, the Internal Monitoring Unit is still in the process of establishing a fraud prevention system

Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia.

To identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia. Data were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural province. These data were accumulated from inpatient medical records from four major disciplines: medicine, surgery, obstetrics and gynecology, and pediatrics. The dependent variable was provider moral hazards, which included indicators of up-coding, readmission, and unnecessary admission. The independent variables are Physicians' characteristics (age, gender, and specialization), coders' characteristics (age, gender, education level, number of training, and length of service), and patients' characteristics (age, birth weight, length of stay, the discharge status, and the severity of patient's illness). We use logistic regression to investigate the determinants of moral hazard. We found that the incidences of possible unnecessary admissions, up-coding, and readmissions were 17.8%, 11.9%, and 2.8%, respectively. Senior physicians, medical specialists, coders with shorter lengths of service, and patients with longer lengths of stay had a significant relationship with the incidence of moral hazard. Unnecessary admission is the most common form of a provider's moral hazard. The characteristics of physicians and coders significantly contribute to the incidence of moral hazard. Hospitals should implement reward and punishment systems for doctors and coders in order to control moral hazards among the providers.

Comparison of Hospitals in Jakarta as Decision-Making Unit for Technical Efficiency and Cost Values: Application of DEA and SFA

The implementation of national health insurance in Indonesia in 2014 as an effort to provide universal health care was known asthe BPJS program. It was named after the responsible agency: Badan Penyelenggara Jaminan Sosial (Health Social Security Administrator). In its early years of implementation, it was indicated that it was not financially optimal because it made a significant financial loss. Therefore, this research was conducted to examine the efficiency level of several hospitals in Jakarta from a technical and cost perspective. The 2018 data was obtained from the Ministry of Health and BPJS. The survey covered 36 hospitals from various regions in Jakarta and was analyzed using Data Envelopment Analysis and Stochastic Frontier Analysis. DEA Solver LV 8 and Frontier 4.1 were the primary tools in this study. There were two significant results of this study. First, most hospitals in Jakarta were efficient in terms of technical efficiency score of DEA (0.73) and SFA (0.52), whereas cost efficiency was mediocre with a score of DEA (0.56) and SFA (0.50). Second, three indices (regional technical efficiency score, regional cost efficiency score, and ownership cost efficiency score) showed similar patterns for DEA and SFA efficiency scores except for the ownership technical efficiency index. It is recommended that the government should immediately improve the centralized national database for hospitals and decide strategic policy to arrange for cooperation between hospitals primarily by sharing their data on hospitals’ load and staff availability.

PRESCRIPTION COST ANALYSIS IN PATIENTS OF TYPE 2 DM AND HYPERTENSION JOINING CHRONIC DISEASE MANAGEMENT PROGRAM (PROLANIS) AT PUSKESMAS AFTER THE IMPLEMENTATION OF NATIONAL HEALTH INSURANCE

To improve the status of public health and carry out social security programs in the health sector, the government started to implement the National Health Insurance. This program covers the participants’ medical care expenses using the capitation system applied in health centers as the First-Level Health Facilities. BPJS Kesehatan has allocated some budget in the form of a capitation rate to first-level health facilities for hypertension and type 2 diabetes mellitus patients after the implementation of National Health Insurance. This research was carried out in 4 health centers, namely Lamper Tengah Health Center, Mangkang Health Center, Mijen Health Center, and Karanganyar Health Center. The data were collected retrospectively from the medical records of 800 patients. The data were analyzed descriptively to determine the prescription cost and Spearman's rho test was used to find the factors that influence the prescription cost. It was revealed that the average prescription cost for type 2 DM patients was IDR 142,293, and for hypertensive patients was IDR 112,735. The prescribing pattern in patients covered by Prolanis program for type 2 DM patients is a combination of glimepiride, metformin with a drug price of IDR 20,670. Factors that have an influence on prescription costs are diagnosis p= 0.033, type of drug (p= 0.000) and drug item (p= 0.000). This study concludes that the factors to influence the drug costs of Prolanis patients at the health centers of Semarang City were the patient's diagnosis, the type of drug given, and the number of drug items given.

Factors Hindering Access to Healthcare Services in Peri-Urban Communities in Johannesburg, South Africa

Access to healthcare is a major problem for diverse reasons in Africa. This study developed a conceptual model to address the factors that hinder patients from accessing and navigating healthcare services in peri-urban communities in Johannesburg, South Africa. A mixed methods research strategy was used to collect both quantitative and qualitative data. Semi-structured interviews and field notes were used for qualitative data collection, while hand-delivered questionnaires were used for collecting quantitative data. Outpatients, administration, and medical personnel that worked at various research sites constituted the sample. The findings identified poor infrastructure, poverty and geographical location as factors hindering healthcare access. Additionally, the study revealed that healthcare policies contributed to the marginalisation of poor communities and recommended a review of such policies to involve various stakeholders. The planned implementation of National Health Insurance and the need for a comprehensive social security system were also recommended as strategies to address the hindrances. Finally, a conceptual model was developed to drive behavioural change in the public and private healthcare systems, leading to affordable and sustainable improvement in accessing, navigating, and using healthcare services.

Policy developer’s perceptions on the implementation of National Health Insurance in South Africa: a qualitative study

BackgroundUniversal health coverage has gained significant momentum internationally as the policy solution to address healthcare system deficiencies and promote equitable distribution of quality healthcare. The South African government has adopted this option and developed policy papers for discussion on a National Health Insurance (NHI) system for South Africa. A large part of the policy has been focused on promoting functionality of the primary healthcare system (PHC); to promote an efficient referral pathway. This study sought to explore potential barriers perceived by policy developers that could hinder achieving the NHI goal. Furthermore, given that a large focus is centred on PHC re-engineering, it was imperative to understand participant’s opinions and perspectives on the role of a pharmacist at this level.MethodsA qualitative research design was adopted in this study. Semi-structured interviews were conducted with ten policy developers that were selected via a referral technique. These were audio recorded using a digital voice recorder on an online platform, transcribed verbatim and saved on Microsoft Word® documents. NVivo®, was utilized to facilitate the analysis of data. A thematic analytical approach was used to categorize codes into themes.ResultsThe findings revealed that participants were in agreement that healthcare system reform is crucial in promoting equitable distribution of healthcare services in South Africa. However, the reality of this is dependent on addressing key concerns perceived by participants that have been reported as three major themes: (1) the benefit of NHI implementation; (2) concerns about NHI implementation; (3) implications for pharmacy.ConclusionsSouth Africa is in the second phase of NHI implementation. This phase is focused on the development of sound NHI legislation and structures. This study identified a number of concerns regarding legislative anomalies and role-player involvement that could compromise the efficient implementation of NHI.

The Role of Jamkeswacht in Helping Cicadas Village Communities Who Experience Health Service Difficulties

Jamkeswatch is a national social health insurance supervisory institution established by the Confederation of Indonesian Trade Unions as a control function for the implementation of National Health Insurance and the Social Health Security Organizing Agency. This is done to ensure that the implementation of health insurance in this country can run as we expect. In addition to criticizing policies, Jamkeswatch also advocates for people who have difficulty having access to health insurance. In this research, we will discuss the role of Jamkeswatch in helping people who experience difficulties, especially in the Cicadas Village area, Bogor Regency.

Predictors of national health insurance membership among the poor with different education levels in Indonesia

BackgroundIndonesia has made significant progress in expanding universal health coverage (UHC) through its National Health Insurance (NHI) mechanism. However, in the context of NHI implementation in Indonesia, socioeconomic disparities caused its subpopulations to have different literacy of NHI concepts and procedures, increasing the risk of healthcare access inequities. Hence, the study aimed to analyse the predictors of NHI membership among the poor with different education levels in Indonesia.MethodsThis study used the secondary dataset of the nationwide survey “Abilities and Willingness to Pay, Fee, and Participant Satisfaction in implementing National Health Insurance in Indonesia in 2019” by The Ministry of Health of the Republic of Indonesia. The study population was the poor population in Indonesia and included a weighted sample of 18,514 poor people. The study used NHI membership as a dependent variable. Meanwhile, the study analysed seven independent variables: wealth, residence, age, gender, education, employment, and marital status. In the final step of the analysis, the study used binary logistic regression.ResultsThe results show that the NHI membership among the poor population tends to be higher among those who have higher education, live in urban areas, are older than 17 years old, are married and are wealthier. The poor population with higher education levels is more likely to become NHI members than those with lower education. Their residence, age, gender, employment, marital status, and wealth also predicted their NHI membership. Poor people with primary education are 1.454 times more likely to be NHI members than those without education (AOR 1.454; 95% CI 1.331–1.588). Meanwhile, those with secondary education are 1.478 times more likely to be NHI members than those with no education (AOR 1.478; 95% CI 1.309–1.668). Moreover, higher education is 1.724 times more likely to result in being an NHI member than no education (AOR 1.724; 95% CI 1.356–2.192).ConclusionEducation level, residence, age, gender, employment, marital status, and wealth predict NHI membership among the poor population. Since significant differences exist in all of those predictors among the poor population with different education levels, our findings highlighted the importance of government investment in NHI, which must be supported with investment in the poor population’s education.

Comparative Politics, Political Settlements, and the Political Economy of Health Financing Reform Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

Nannini et al analyze barriers to national health insurance reforms in Uganda using a political economy approach primarily rooted in stakeholder analysis. This approach is valuable, not only for its clear description of the interest-based politics at play, but also for its extension of stakeholder analysis to include consideration of the role of ideas and institutions in the policy process. However this analysis, and others like it, could be further strengthened by adding insights from two different sources. The first is the comparative politics literature on the Ugandan regime. The second is a related approach which analyzes public service delivery in the context of a country's underlying "political settlement." Stakeholder-based approaches to health financing reform emphasize interest group conflict about the contents of policy reforms. By contrast, these complementary approaches imply distinct barriers to successful implementation of national health insurance in Uganda, rooted in the regime's de-industrialization and the personalization of politics and resource allocation. They also suggest possible leverage points or avenues for progress which differ from those suggested by stakeholder analysis.

Willingness to pay for a National Health Insurance (NHI) in Saudi Arabia: a cross-sectional study

BackgroundHealthcare services in Saudi Arabia are provided free of charge to its citizens at the point of use. Recently, however, the government has realized that this model is unsustainable in the long run. Therefore, Saudi decision-makers are seeking to have a sustainable health system through the introduction of a contributory National Health Insurance that require making regular financial contributions from its members.ObjectiveThis study aims to explore the people’s willingness to pay for a National Health Insurance system in Saudi Arabia. The study also aims to understand the factors affecting their willingness or unwillingness to pay NHI, such as, their demographic and socio-economic characteristics, the type of their usual health care provider, and their satisfaction with the current healthcare services.MethodsA cross-sectional study design with Contingent Valuation (CV) technique was used to measure the value of National Health Insurance based on an individual’s willingness to pay. The data were collected from 475 participants using an online survey via Google Forms between March 2021 and April 2021. Frequencies, logistic regression, and linear regression, were conducted to answer the research questions.ResultsThe number of individuals who was willing to pay for NHI was higher than those who were not willing to pay (62.9, 95% CI = 58.4-67.3%) vs (37.1, 95% CI = 32.7-41.6%). A binomial test found this difference was statistically significant (p < 0.001). There was a significant association between the likelihood of paying for NHI and type of usual healthcare provider (OR = 3.129, 95% CI = 1.943-5.039, p < 0.001); as individuals using public health services were more likely to pay for NHI. Also, with satisfaction with health services (OR = 14.305, 95% CI = 3.240-63.153, p < 0.001), as individuals who were very satisfied with the healthcare services were more likely to pay for NHI. The median amount of money the people were willing to pay as a monthly contribution for NHI was 100 SAR (26.5 USD) with the average being 152 SAR (40 USD). There was a significant association between the maximum amount the participants were willing to pay and age, region, and education. Specifically, 30–39-year-olds were willing to pay more for NHI compared to participants aged 50 or older (ß = 103.55, 95% CI = 26.27- 199.29); participants from central region more than participants from northern region (ß = 70.71,95% CI = 2.14- 138.58); and participants with masters degree more than participants with PhDs (ß = 227.46, 95% CI = 81.59- 399.28).ConclusionThis study provided some evidence that more people were willing to pay for NHI than those who declined. Individuals who frequently used public health services and were very satisfied with these services were more willing to pay for NHI. Younger population, those with master’s degree, and from the central region were willing to pay more amount of money for NHI. These results could help policy makers shape their decisions and anticipate problems that may arise with NHI implementation.

Efficacy and Safety of Topical Urea for Treatment Atopic Dermatitis as a Reference in the National Drugs Formulary

Atopic dermatitis (AD) is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. One of the most important clinical features of AD which results from a dysfunctional epidermal barrier (EB) is very dry skin (xerosis). Moisturizers are often used as supplements to topical and/or systemic anti-inflammatory drugs in various types of skin conditions and disorders. Humectan, this class of moisturizer is used to improve the appearance and texture of skin by filling in the crevices between corneocytes. One of the humectant included in the list of the National Drugs Formulary that is needed and must be available at health service facilities as a reference in the implementation of National Health Insurance (NHI) is urea. The literature searches using Pubmed, Academia, Google scholar and published in the last 10 years. Urea is effectively increasing skin hydration as well as niacinamide, significantly reducing local Scoring Atopic Dermatitis (SCORAD) and stratum corneum (SC) hydration. Urea had a decrease in transepidermal water loss (TEWL) which was not significantly better than lanolin and ceramide. The ceramide had a lower mean Visual Analogue Scale (VAS) score for irritation compared with the urea. More participants also preferred the ceramide-based cream over the urea. Urea is an effective and safe treatment although not as well as ceramide. Ceramide has been shown to be more effective and less irritating than urea. Ceramid can be quite expensive, while urea is a moisturizer that is easily found and accessible to the public.