Regional inequalities of national health insurance enrollment in Indonesia in 2019

Ensuring universal access to essential health services is a key policy goal, with efforts to minimize inequities being crucial. Even though the National Health Insurance (NHI) targets 95% enrollment coverage by the end of 2019, it only reached 85.3%. This study investigated regional inequalities in NHI enrollment across Indonesia. This cross-sectional study analyzed data from 47,644 respondents. Variables analyzed comprised NHI membership as the outcome and region as the exposure, with seven control variables: residence, age, gender, education, employment, marital status, and socioeconomic status. We employed binary logistic regression in the final analysis. The results showed that Indonesia's nationwide average NHI membership was 67.2%. In Sumatra, the likelihood of NHI membership was 50% less than in Papua (95%CI 0.42-0.60). Java and Bali regions had a 0.48 times lower likelihood of NHI membership than Papua (95%CI 0.40-0.58). Nusa Tenggara and Kalimantan regions had 0.56 and 0.44 times lower likelihoods, respectively, compared to Papua (95%CI 0.46-0.69; 95%CI 0.36-0.53). Maluku was 0.29 times less likely than Papua to be NHI members (95%CI 0.23-0.38). No significant differences were found between the Sulawesi and Papua regions. The study concluded that regional inequalities persist in Indonesia, with all areas except Sulawesi less likely than Papua to enroll in NHI. We need to start outreach projects in places like Sumatra, Java, and other islands where the number of NHI members is low. The Indonesian government needs to send mobile teams there to give people in remote and underdeveloped places direct access to NHI registration services.