Socioeconomic disparities in outpatient treatment utilization among Indonesian older adults: findings from the 2015 and 2020 National Socioeconomic Survey

With an aging population, Indonesia must monitor health inequities and promote healthy aging. This study explores the trends and disparities in outpatient treatment utilization among Indonesian older adults across socioeconomic position (SEP), following the implementation of universal health coverage in 2014. The unit of analysis includes 27,708 and 29,905 non-institutionalized Indonesian older adults aged 60 and over with poor self-rated health status residing in 413 and 514 districts, respectively. The data were obtained from the combined datasets of the 2015 National Socioeconomic Survey and 2014 Village Data Census. Outpatient treatment utilization is the outcome variable. SEP is assessed by household wealth index and educational attainment. The slope index of inequality (SII) is calculated using multilevel-adjusted prevalence estimates ( P < 0.05). After adjusting for age, health insurance, and percentage of villages in district with primary care services, older adults in the highest SEP accessed outpatient more than those in the lowest SEP in both 2015 ( P < 0.001 for education and for wealth) and 2020 ( P < 0.001 for education and for wealth). The SII revealed a statistically significant increase in the disparity in outpatient between the highest and lowest educational levels from 2015 (14.1%, P < 0.001) to 2020 (16.9%, P < 0.001). The proportions of older adults with both the highest (-7.2%, P < 0.001) and lowest (-9.4%, P < 0.001) education levels accessing outpatient decreased. Between 2015 and 2020, the SII demonstrated a statistically significant decrease in the disparity between the highest (15.2%, P = 0.01) and lowest (12.4%, P = 0.03) wealth groups. The proportion of older adults in both the highest (-7.1%, P < 0.001) and lowest (-5.8%, P < 0.001) wealth groups accessing outpatient declined. Macro-level policy interventions aimed at increasing outpatient treatment coverage should target all older adults, regardless of SEP. Further research into the broader macro-social context is warranted.