Bikker, Annemieke

English

AbstractBackgroundAchieving Universal Health Coverage (UHC) worldwide is part of the international health agenda as reflected in the United Nations' Sustainable Development Goals. UHC is important for people suffering from mental health conditions because it provides access to essential quality health services and reduces out-of-pocket spending. Indonesia - a low-middle income country - launched a stepwise UHC in 2014. Recent figures indicate that 9.8% of the Indonesian population suffers from a mental health condition, though this is likely to be an underestimation. Thus, the introduction of the UHC is perceived as a key element in improving Indonesian mental health outcomes.AimThis study aimed to obtain insight into psychiatrists’ experiences of the UHC and how it affects their daily practice.MethodThis cross-cultural, qualitative study was conducted in Bali, Indonesia in 2018. From the 52 active psychiatrists, 27 participated in an in-depth semi-structured interview. We followed an interpretivist approach. Transcripts and fieldnotes were coded and analysed through thematic analysis, and we arrived at two themes. The relevant ethical approvals were obtained.Findings1. Patients accessing services.Most participants did not notice an increase in the number of patients accessing their services since the UHC. However, they noticed a shift in the types of conditions that patients presented, which they attributed to a reduction in financial barriers and increased awareness of mental health. Yet, many acknowledged that stigmatisation and supernatural beliefs continued to be strong.2. Providing quality mental healthcare.Most psychiatrists experienced some limitations from the UHC that affected the efficiency of care. With the UHC covering only ICD diagnostic codes and for the duration of a fixed period for treatment, psychiatrists faced challenges when faced with cultural illnesses and long-term conditions.Conclusions and implicationsUHC is promoted internationally as a clear pursuit of equity and social justice. While, according to the participants in our study, the UHC improved access to mental healthcare in Indonesia to some extent, cultural belief systems and integration of services for patients with chronic mental illness are also key to patients’ recovery that need to be taken into account

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     Edinburgh Research Explorer                                      A qualitative study on psychiatrists’ experiences of the UniversalHealth Coverage in psychiatric daily practice in IndonesiaCitation for published version:Niko Tiliopoulos, Cokorda Bagus Jaya Lesmana & Bikker, A 2021, 'A qualitative study on psychiatrists’experiences of the Universal Health Coverage in psychiatric daily practice in Indonesia', Trinity Health andEducation InternationalResearch Conference, 10/03/21 - 11/03/21.Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 23. Jul. 2021Emergency Medicine Research Group Edinburgh (EMERGE)O’Brien, R., Black, P.L. MethodThis is a cross-cultural qualitative study in line with theinterpretivist approach. We conducted semi-structuredinterviews with half (i.e. 23) of the psychiatrists workingin Bali, Indonesia, sampled from different regencies..Data were analysed through thematic analysis..AimTo obtain insight into psychiatrists’ experiences of the Universal Health Coverage (UHC) with a focus on improving access and care.A qualitative study on psychiatrists’ experiences of the Universal Health Coverage (UHC)in psychiatric daily practice in IndonesiaAnnemieke Bikker1, Niko Tiliopoulos2, Cokorda Bagus Jaya Lesmana3We welcome questions and suggestions:Annemieke.Bikker@ed.ac.uk, Usher Institute, The University of EdinburghBackgroundIndonesia, a middle-income country, introduced theUniversal Health Coverage (UHC) in 2014. UHC isimportant for people suffering from mental healthconditions because it aims to achieve equity inaccess to essential quality health services and itreduces out-of-pocket spending. The IndonesianNational Health Survey indicates that 9.8% of thepopulation suffer from a mental condition with manynot receiving treatment.Project Funded bythe Sydney Southeast Asia Centre, and the Udayana International Research Collaboration Grant. Udayana UniversityBangli psychiatric hospitalFindings1. Patients accessing servicesMost participants noticed a small increase in the numberof patients accessing services, and a shift in the types ofconditions presented.Concerns remained about lack of access in rural areas ormore deprived regencies. Stigmatisation and supernaturalbeliefs were perceived as delaying help seeking.2. Providing quality mental healthcarePsychiatrists experienced ongoing challenges with theUHC that affected the efficiency of care and patientrelapse. These restrictions related to the UHC coveringonly ICD diagnostic codes, and a lack of resources andintegrated system between primary care and psychiatricservices.They have faith in the traditional healer so if they see one and the patient is getting better then they don’t think they need to go to the hospital. Who will support the chronic patient? Cause they might need more medicine, more treatment, but the UHC would like to pay the lowest medicine for a short period….It’s hard if we give good medicine here, then we discharge them into the community, but there is not the same medicine. ConclusionUHC is promoted internationally as a clear pursuit of equity and social justice. While, according to the participants inour study, the UHC improved access to mental healthcare in Indonesia to some extent, cultural belief systems andintegration of services for patients with chronic mental illness are key to patients’ recovery and still need to be takeninto account.2 3 1

A qualitative study on psychiatrists’ experiences of the Universal Health Coverage in psychiatric daily practice in Indonesia

https://www.research.ed.ac.uk/files/209119255/Bali_UHC_Poster_THEconf2021_9_11March2021_v1.pdf

A qualitative study on psychiatrists’ experiences of the Universal Health Coverage in psychiatric daily practice in Indonesia

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