Explaining Indonesian Patients’ Experiences About Changes in the Hemodialysis Cost System
Abstract
Aim: To explore the experience of haemodialysis patients in Indonesia over a decade, amidst changes in the cost system in hospitals. Since its implementation, the Universal Health Coverage (UHC) policy has significantly influenced haemodialysis services in hospitals, affecting patients' experiences.
Material and Methods: Qualitative study. Twenty-two haemodialysis patients selected by snowball sampling from the Indonesian Dialysis Patient Community (Komunitas Pasien Cuci Darah Indonesia) participated. Data were collected through interviews, transcribed and analysed thematically, and psychological methods based on patients' experiences were used.
Results: identified three main themes (health coverage system, haemodialysis services, haemodialysis facilities) and ten sub-themes (complex monthly payment situation for care recipients, unexpected deactivation of payment status, outdated referral system requirements, payment system complications for care recipients, penalty for late payments, disparities in services between hospitals, insufficient coverage for certain services, accessibility problems with distant haemodialysis units, variations in types of haemodialysis equipment, and inadequate comfort in the family waiting room).
Conclusions: The health insurance system needs to be improved to increase access, equity, affordability, efficiency, consistency and quality of haemodialysis services in Indonesian hospitals. Collaborative efforts by the government, health institutions and related parties are essential.
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References
Christopher Dye, Ties Boerma, David Evans, Anthony Harries, Christian Lienhardt, Joanne McManus, Tikki Pang, Robert Terry RZ. Research for universal health coverage [Internet]. Vol. 5, World Health Organization. Luxembourg; 2013. Available from: https://www.afro.who.int/publications/world-health-report-2013-research-universal-health-coverage
Kementrian Kesehatan RI. Indonesia Health Financing System Assessment [Internet]. Jakarta; 2014. Available from: https://siha.kemkes.go.id/portal/files_upload/1_e__HFSA_FINAL_Published.pdf
Kementerian Kesehatan RI. Laporan Kajian Efektifitas Sistem Pembayaran Kapitasi Khusus di Daerah Terpencil dan Kepulauan Tahun 2018 [Internet]. UGM. Yogyakarta; 2004. Available from: https://kebijakankesehatanindonesia.net/images/2018/Laporan_Kapitasi_Khusus.pdf
Kementerian Kesehatan RI. Buku Panduan Jaminan Kesehatan Nasional (JKN) Bagi Populasi Kunci [Internet]. Jaminan Kesehatan Nasional. Jakarta: Kementerian Kesehatan RI; 2016. 1–39 p. Available from: https://siha.kemkes.go.id/portal/files_upload/BUKU_PANDUAN_JKN_BAGI_POPULASI_KUNCI_2016.pdf
Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication—worldwide more than 850 million individuals have kidney diseases. Kidney Int [Internet]. 2019;96(5):1048–50. Available from: https://doi.org/10.1016/j.kint.2019.07.012
PERNEFRI. 11th Report Of Indonesian Renal Registry 2018. Indones Ren Regist [Internet]. 2018;1–46. Available from: https://www.indonesianrenalregistry.org/data/IRR 2018.pdf
Agustina F, Yetti K, Sukmarini L. Contributing factors to hemodialysis adherence in Aceh, Indonesia. Enferm Clin [Internet]. 2019;29(S2):238–42. Available from: https://www.elsevier.es/en-revista-enfermeria-clinica-35-articulo-contributing-factors-hemodialysis-adherence-in-S113086211930124X
Alhamad MA, Almulhim MY, Alburayh AA, Alsaad RA, Alhajji AM, Alnajjar JS, et al. Factors Affecting Adherence to Hemodialysis Therapy Among Patients With End-Stage Renal Disease Attending In-Center Hemodialysis in Al-Ahsa Region, Saudi Arabia. Cureus [Internet]. 2023;15(10):1–11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630638/
Kim S, Lee HZ. The Lived Self-Care Experiences of Patients Undergoing Long-Term Haemodialysis: A Phenomenological Study. Int J Environ Res Public Health [Internet]. 2023;20(6):1–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10048782/
Sunariyanti E, Andayani TM, Endarti D, Puspandari DA. Cost Analysis of Chronic Kidney Disease Patients in Indonesia. Clin Outcomes Res [Internet]. 2023;15(June):621–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393018/pdf/ceor-15-621.pdf
Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378–95.
Yao X, Chen S, Lei W, Shi N, Lin W, Du X, et al. The relationship between hemodialysis mortality and the Chinese medical insurance type. Ren Fail [Internet]. 2019;41(1):778–85. Available from: https://doi.org/10.1080/0886022X.2019.1657893
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Heal Care [Internet]. 2007;19(6):349–57. Available from: https://pubmed.ncbi.nlm.nih.gov/17872937/
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Detollenaere J, Hanssens L, Vyncke V, De Maeseneer J, Willems S. Do we reap what we sow? Exploring the Association between the Strength of European primary healthcare systems and inequity in unmet need. PLoS One [Internet]. 2017;12(1):1–13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5207486/
Başar D, Dikmen FH, Öztürk S. The prevalence and determinants of unmet health care needs in Turkey. Health Policy (New York) [Internet]. 2021;125(6):786–92. Available from: https://www.sciencedirect.com/science/article/pii/S0168851021001044
Muhlis ANA. Determinants of the National Health Insurance Uptake in Indonesia. Indones J Heal Adm [Internet]. 2022;10(1):111–21. Available from: https://e-journal.unair.ac.id/JAKI/article/view/27746/21820
Glidewell L, Boocock S, Pine K, Campbell R, Hackett J, Gill S, et al. Using behavioural theories to optimise shared haemodialysis care: A qualitative intervention development study of patient and professional experience. Implement Sci [Internet]. 2013;8(1):1–17. Available from: Implementation Science
Hartanti LK, Antonio F. The Effect of Service Quality Dimensions on Hemodialysis Patient Satisfaction in Indonesia. J Adm Kesehat Indones [Internet]. 2022;10(1):50–9. Available from: https://e-journal.unair.ac.id/JAKI/article/view/28554
Widyawati IY, Nursalam N, Kusnanto K, Hargono R, Hsieh PL. Grieving as an Internal Factor of Nurse-Patient Interaction in a Dialysis Unit. J Ners [Internet]. 2018;13(1):64–71. Available from: https://e-journal.unair.ac.id/JNERS/article/view/8005/pdf
Wahyuni ED, Haloho FNW, Asmoro CP, Laili NR. Factors Affecting Interdialytic Weight Gain (IDWG) in Hemodialysis Patients with Precede-Proceed Theory Approach. IOP Conf Ser Earth Environ Sci. 2019;246(1):1–7.
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