Path Analysis on the Equity of Hemodialysis Utilization in the National Health Insurance Program in Jember, East Java

Background: Since 2014, Indonesia has implemented a National Health Insurance to cover pu­blic health costs. The existence of health insurance managed by the government is expected to help all levels of society to obtain health services. This is very helpful for the community, especially for pa­tients with chronic diseases who need continuous treatment. This study aims to analyze the fair­ness and determinants of the use of hemodialysis patients with chronic kidney failure in National He­alth Insurance participants in Jember Regency.Subject and Method: This was observational analytic study with cross sectional approach, conducted at Dr. Soebandi Hospital and Kaliwates General Hospital, Jember, East Java. A total Study subjects of 200 patients with chronic kidney failure undergoing hemodialysis with JKN membership we­re selected for this study by purposive sampling. The dependent variable was the use of hemo­dia­lysis. The independent variables were JKN membership status, length of time since diagnosis, di­sease severity, age, education, family income, access to health facilities and residence. Data col­lec­tion used questionnaires and medical record documents and then analyzed using path analysis.Results: The possibility of using hemodialysis was increased by the Non PBI status (b= 0.81;  95% CI= 0.16 to 1.47; p= 0.015), high disease severity (b=2.48;  95% CI=0.36 to 4.59; p= 0.022), age ≥ 50 years old (b=0.65;  95% CI = 0.33 to 1.26; p= 0.039), family income ≥ MW (b= 0.59;  95% CI= -0.07 to 1.24; p= 0.080)  and good access to health facility (b= 0.92;  95% CI= -0.19 to 1.66; p= 0.013). The possibility of using hemodialysis was indirectly affected by the length of time since diag­nosis, education and residence.Conclusions: The possibility of using hemodialysis was increased by Non PBI status, disease se­ve­rity, age, family income, and access to health facilities. The possibility of using hemodialysis was in­directly affected by the length of time since diagnosis, education, and residence.Keywords: National Health Insurance, justice, hemodialysis, path analysisCorrespondence: Siti Nafi’atus Salamah. Public Health Sciences Study Program, Universitas Sebelas Maret. Jl. Ir. Su­ta­mi 36 A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 081289434401Journal of Health Policy and Management (2020), 5(2): 108-120https://doi.org/10.26911/thejhpm.2020.05.02.0