ASSESSING THE DISTRIBUTION OF SELF-PAYING INNOVATIVE ONCOLOGY MEDICINES AMONG CANCER PATIENTS

Background: Innovative oncology medicines offer advanced cancer treatment but often come with high costs, limiting access through public healthcare funding. Aims: This study examines the distribution of self-paying innovative cancer drugs among patients in Malaysian public hospitals. Methods: Using oncology pharmacy records from 2017 to 2020, 157 patient samples were collected, constrained by COVID-19 restrictions. Results: The average patient age was 57 years (SD= 11.47), with a predominance of females (73.9%) and Chinese ethnicity (48%). Breast cancer was the most common diagnosis (47%), followed by lung (17%) and colon cancer (10%). Frequently prescribed drugs included Trastuzumab, Palbociclib, Osimertinib, Cetuximab, and Bevacizumab, most of which are listed in the Ministry of Health’s Formulary of Listed Anticancer Drugs (FLAD). Patients paid an average annual cost of MYR 16,233.90 (SD= 20,424.67) for FLAD medicines and MYR 11,239.75 (SD= 122,793.50) for non-FLAD medicines. Conclusion: The study highlights that out-of-pocket payments are the primary funding source for these treatments, posing significant financial burdens and potential long-term economic strain on cancer patients in Malaysia. Keywords: FLAD, Funding Mechanism, Innovative Oncology Medicin

CAN EDUCATION INCREASE NHI MEMBERSHIP? A CASE STUDY AMONG MADURESE IN INDONESIA

Background: Madura Island is often left behind in health development in East Java Province, including in the health sector. Poverty and poor education dominate this region. Aims: The research examined the role of education in National Health Insurance (NHI) membership among Indonesian Madurese. Methods: The study employed 791 respondents. We used NHI membership as an outcome variable, education level as an exposure variable, and seven control variables: regency, residence, gender, employment, age, wealth, and marital status. In the last stage, we employed a binary logistic test. Results: The results showed that 58.2% of Madurese people in Indonesia are members of the NHI. Regarding education level, Madurese with primary education was 1.672 times more likely than those without formal education to be an NHI member (95% CI 1.662-1.683). Meanwhile, Madurese with secondary education was 2.329 times higher than those uneducated to be an NHI member (95% CI 2.306-2.352). Moreover, Madurese with higher education was 4.593 times more likely to be an NHI member than uneducated Madurese (95% CI 4.517-4.669). Conclusions: Education level was associated with NHI membership among Madurese in Indonesia. The higher the education level, the higher the possibility of being an NHI member. Keywords: health insurance, National Health Insurance, Madurese, big data, public healt

THE COST OF TREATMENT FOR PEDIATRIC TUBERCULOSIS PATIENTS: A CROSS-SECTIONAL STUDY

Background: Tuberculosis (TB) is a leading global communicable disease. Pediatric tuberculosis, in particular, is prevalent among the population aged 0-14 years and necessitates a treatment duration of at least six months. Aims: This study aims to assess the total treatment cost of pediatric tuberculosis patients and determine the factors associated with the total cost. Methods: A cross-sectional design was employed to collect the retrospective data at a public hospital and PHC in the province-level Special Region of Yogyakarta, Indonesia. Treatment costs are categorized into the following: laboratory costs, professional costs, drug costs, medical and non-medical support costs, and miscellaneous costs. The collected data underwent both descriptive and statistical analysis using regression methods, namely logistic and probit regressions. Results: The analysis revealed that most patients were between 0 and 2 years old and most of them are school-age, with an average treatment cost of USD 62.80 per patient. The study identified laboratory costs (RR 0.198; 95% CI 0.083-0.314), professional costs (RR 9.402; 95% CI 4.108-14.698), drug costs (RR 5.269; 95% CI 2.326-8.212), and medical support costs (RR 0.223;95% CI 0.064-0.382) as the primary contributors to the total cost. Conclusion: The point of this study is that effective treatment is possible with proper financial support. To achieve a successful outcome in treating pediatric tuberculosis, it is imperative to establish an advocacy and collaboration effort to enhance the primary health services. This cooperative effort should prioritize convenient access to treatment and enhancing active case finding. Keywords: cost of illness, cost of treatment, pediatric tuberculosi

THE ROLE OF PRENATAL CLASSES IN EXCLUSIVE BREASTFEEDING: EVIDENCE FROM PAPUA, INDONESIA

Background: Exclusive breastfeeding (EBF) is a lifesaving practice for infants in vulnerable conditions. Therefore, it is crucial to ensure the optimization of EBF coverage in disadvantaged areas. One of the barriers to EBF is limited maternal knowledge, and prenatal classes are designed to improve maternal health knowledge and practices. Aims: The study aimed to analyze the role of prenatal classes in supporting EBF in Papua. Methods: The cross-sectional study examined 640 mothers with children aged 0-5 months from the Papua Region. Prenatal classes were an exposure variable, while EBF practice served as an outcome variable. Nine control variables, including age, marital status, education, work, wealth, sex, infant age, and early initiation of breastfeeding (EIBF), were incorporated into the analysis. Binary logistic regression test was used for analysis. Results: The proportion of EBF in Papua is 50.7%. Mothers who participated in prenatal classes were 1.560 times more likely to practice EBF than those who did not (AOR = 1.560; 95% CI [1.476-1.649]). Additionally, the study identified nine control variables related to EBF in the Papua Region: type of residence, maternal age group, maternal marital status, education level, employment status, wealth status, infant age, infant sex, and EIBF.   Conclusion: Participation in prenatal classes is positively associated with the achievement of EBF practice in the Papua Region. Additional characteristics associated with a higher likelihood of EBF among Papuan mothers included having a higher level of education and employment, living in rural regions, experiencing poverty, being married, and achieving successful EIBF. Keywords: exclusive breastfeeding, Papua, prenatal classes, public health, public health nutritio

THE HIDDEN ECONOMIC BURDEN OF LEPTOSPIROSIS: HEALTHCARE COSTS AND PATIENT IMPACT

Background: Leptospirosis is a public health issue caused by the Leptospira bacterium, leading to significant economic impacts. The cost of illness due to Leptospirosis encompasses hidden costs that significantly affect individuals and society Aims: This study aimed to assess the hidden economic burden (direct and indirect costs) experienced by patients and their families due to healthcare treatment of leptospirosis. Methods: This descriptive cross-sectional study was conducted in Banyumas Regency from February to June 2024. Data were collected from patients who completed leptospirosis treatment in 2023. The variables of cost were categorized into direct treatment cost, treatment cost, and indirect cost, which were analyzed descriptively.   Results: Most leptospirosis patients were male, aged 26 – 45 years old, and the majority worked as farmers. Our study reveals that uninsured patients incurred higher out-of-pocket expenses during leptospirosis’ treatment. The productivity loss was estimated at USD 44.75, with significant hidden costs being transportation (USD 31.90), caregiver support (USD 86.38), and hospital treatment (USD 231.40). Conclusion: The significant burden of Leptospirosis in Indonesia highlights the economic impact on individuals and the challenges within the healthcare system. This study calls for enhanced public health strategies focused on prevention, early diagnosis, and improved healthcare access to address the leptospirosis burden effectively. Keywords: Cost of illness, economic burden, financial impact, leptospirosis, productivity los

THE APPLICATION OF STANDARDIZED HEALTH SERVICE FEES IN THE HEALTH INSURANCE SCHEME

Background: The implementation of the Indonesian Minister of Health Regulations No. 3 of 2023 on the standard health service tariff in the national health insurance program, as a replacement for the previous policy, has created confusion among field implementers. The capitation rate is considered sufficient but is sometimes insufficient to cover Public Health Care (PHC) operational costs. Aims: This study aims to analyze standard health service tariffs in the implementation of the health insurance program at PHCs.  Methods: The authors used descriptive qualitative methods with a case study as the research design. The unit of analysis was the health service tariff standards at the PHCs. Data collection techniques involved snowball discussions followed by FGDs. Research subjects were selected using a purposive sampling technique. The FGDs consisted of 3 participants from BPJS Kesehatan, 4 from the public health centers, 2 people from private clinics, and 3 individual practitioner doctors. Data were analyzed using Open Code software. In addition, a policy analysis of PHC tariff standards was also conducted.  Results:  PHCs have implemented the Minister of Health Regulations No. 3 of 2023 since February 2023. In the implementation of health service tariff standards at the PHCs, no significant obstacles were encountered, as they adjusted to the applicable policies. Although the tariff standards follow Minister of Health Regulations No.3 of 2023 and include an increase in the capitation value compared to the previous policy, the amount is perceived as inadequate and still below the reasonable cost required for service delivery. Private clinics and individual practitioners must still cover operational expenses using capitation funds supplemented by income from non-insured patients to meet operational costs related to human resources, equipment, and supporting facilities. Conclusion: PHCs have implemented the standard health service tariff in accordance with the existing policy. However, the increase in capitation fees has not fully covered the costs at PHCs. Keywords: health service; PHC; tariff standar

DETERMINANTS OF WORK MOTIVATION AMONG DOCTORS AT COMMUNITY HEALTH CENTERS IN INDONESIA

Introduction: Effective work motivation among healthcare professionals significantly enhances health service performance and plays a pivotal role in improving service quality. Aims: This study aims to analyze the determinants influencing work motivation among doctors at community health centers in Indonesia. Methods: This study employed a quantitative approach with a cross-sectional design, utilizing secondary data from the 2017 Indonesian Workforce Research in the Health Sector. The study sample comprised 9,988 respondents. Logistic regression was employed for data analysis. Results: In 2017, 55.1% of doctors at community health centers in Indonesia reported high work motivation. Significant correlations were identified between work motivation and various factors: individual characteristics (age, education, marital status, position), intrinsic factors (training and continuing education), extrinsic factors (salary/wages, work area), financial incentives (performance allowances, capitation fund incentives), and non-financial incentives (official vehicles) (p < 0.05). Among these, the type of position was identified as the most dominant factor influencing work motivation (p < 0.05; prevalence ratio (PR) = 1.805 CI 95% [1.608-2.028]). Conclusion: Work motivation among doctors at community health centers in Indonesia is significantly influenced by individual characteristics, intrinsic and extrinsic factors, as well as financial and non-financial incentives, with the type of position being the most dominant factor. To enhance motivation and improve healthcare services, policymakers should strengthen career development, expand training opportunities, improve financial and non-financial incentives, and implement targeted retention strategies, especially in underserved areas. Keywords: Community health center, doctor, Indonesia, work motivatio

RETENTION OF REMOTE PUBLIC HEALTH CENTER DOCTOR IN NORTH KONAWE DISTRICT

Background: Remote public health centers (PHCs) have the highest proportion of PHCs without doctors, with Southeast Sulawesi Province ranking fifth in this regard. PHCs serve as the main gateway to health services in rural and remote areas. Despite its high fiscal capacity and provision of support for medical education and incentives, North Konawe District has not succeeded in retaining doctors in its public health centers. Aims: This study aims to analyze factors that influence the retention of doctors in remote PHCs in the North Konawe District. Methods: This qualitative study employed a case study design, involving in-depth interviews with 14 informants and a review of six documents. Results: Factors affecting doctor retention in the North Konawe District include individual factors, work factors, living environment factors, and health system factors. Conclusion: Doctors in remote PHCs in North Konawe District are Ministry of Health placement doctors working on temporary contracts. Strategies to improve the retention of doctors in remote PHCs include improving living conditions in remote areas, supporting job opportunities for doctors' spouses, recruiting doctors early in their careers, implementing government disincentive policies, building PHCs with official housing, requiring mandatory service for recipients of medical education scholarships, and developing doctor attendance information systems. Keywords: Doctor, PHC, remote area, retention

PRIVATE HEALTH INSURANCE OWNERSHIP IN A SOCIAL HEALTH INSURANCE DOMINATED SYSTEM

Background: Private health insurance coverage in Indonesia remains very limited, which may increase financial vulnerability despite the dominance of social health insurance.  Aims: This study examines factors associated with private health insurance ownership among the Indonesian population. Methods: A cross-sectional study was conducted using data from the 2023 National Socio-Economic Survey (SUSENAS), including 179,339 respondents aged 15–64 years. Multiple logistic regression was applied to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals, controlling for demographic, socioeconomic, and health-related factors Results: The prevalence of private health insurance ownership was 0.5%. Higher education, married status, rich economic status, exposure to internet media, and absence of health complaints were significantly associated with a higher likelihood of ownership. In contrast, respondents aged 25–34 years, those living in households with fewer than five members, and employed individuals were significantly less likely to own private health insurance. Rich economic status was the strongest predictor of private health insurance ownership (adjusted PR = 3.353; 95% CI: 1.997–5.627).  Conclusion: Private health insurance ownership in Indonesia is strongly shaped by socioeconomic characteristics and information exposure. These findings provide empirical evidence to support further investigation into the role of private health insurance as a complementary mechanism within Indonesia’s social health insurance-dominated system. Keywords: Indonesia, ownership, private health insurance, socioeconomic factor

SOSIODEMOGRAPHIC DETERMINANTS OF HEALTH FACILITY UTILIZATION IN INDONESIA: Determinan Sosiodemografi Utilisasi Pelayanan Kesehatan di Indonesia

Background: Health service facility utilization is crucial for determining healthcare service success and accessibility. Sociodemographic factors significantly influence utilization patterns. Aims: This research aims to examine the relationship between sociodemographic factors and health facility utilization patterns among the Indonesian population Methods: Secondary data from the 2023 Indonesian Health Survey (Health Development Policy Agency, Ministry of Health) were analyzed using a quantitative cross-sectional approach. Chi-square tests and binary logistic regression were employed for bivariate and multivariate analyses Results: Non-JKN health insurance was the dominant factor with PR = 2.4 (95%CI PR: 2.335-2.645), followed by never in union with PR= 1.328 (95%CI PR:1.269-1.390). Married with PR= 1.3 (95%CI PR: 1.224-1.381), unemployed with PR= 1.262 (95%CI PR: 1.226-1.300), children with PR= 1.181 (95%CI PR: 1.110-1.257), men with PR =1.030 (95% CI PR: 1.005-1.005). Factors reducing utilization likelihood included are rural residence with PR= 0.378 (95%CI PR: 0.368-0.388), secondary education with PR= 0.390 (95%CI PR: 0.376-0.404), adult with PR= 0.650 (95%CI PR: 0.603-0.701), primary education with PR= 0.703 (95%CI PR: 0.684-0.722), non formal occupation with PR= 0.955 (95%CI PR: 0.922-0.989). Conclusion: The binary logistics regression shows that health insurance ownership is the most dominant predictor, with individuals holding non-JKN health insurance being 2.4 times more likely to utilize healthcare services compared to those with JKN insurance. Therefore, geographical disparities and educational levels are critical obstacles that require intervention in efforts to improve access to health services. Keywords: Determinants, Health Facility, Sociodemographic, Utilization, SKI 202