Achieving universal health coverage with disability inclusion: a household survey analyzing healthcare access and national health insurance utilization for individuals with disabilities in Indonesia

Indonesia, the largest archipelagic nation, is committed to ensuring that persons with disabilities (PWDs) have access to healthcare services without catastrophic costs. This study investigates health-seeking behaviors among individuals with physical and sensory disabilities in Indonesia and the factors associated with their preference for accessing health facilities, utilizing the national health insurance (the JKN) to cover the costs of healthcare services. This study employed a cross-sectional design. In 2024, we surveyed 2,666 PWDs across six districts, who were from Yogyakarta City, Bantul, Denpasar City, Buleleng, Kupang City, and Kupang Rural districts, representing variations in access to healthcare, fiscal capacity and healthcare system developments. The outcomes of this study encompassed PWDs’ healthcare-seeking behaviors, their JKN utilization and out-of-pocket payments. Most PWDs in these districts reported a high need for health services; however, only 50% of them accessed health facilities. Although a high rate of insurance enrollment around 88%, was observed, barriers to accessibility and financial capacity for accessing healthcare service points still persist. Regression analyses revealed that having diagnoses made by healthcare workers was associated with the outcomes, whereas being registered with the JKN was associated with seeking assistance. Health service costs for those accessing primary healthcare centers and private clinics were affordable, whereas the costs at the hospital level were not. Population access and the JKN utilization differed across districts. Although Indonesia is making progress toward universal health coverage, by successfully enrolling almost PWDs and ensuring affordable health services in primary care, low rates of access to health facilities and use of the insurance still persist. Tackling those challenges requires not only health-sector interventions but also socio-economic programs. Enhancing local government efforts to overcome district-specific barriers and variations in progress can speed up the integration of a disability inclusion agenda.