The maternal mortality rate in Indonesia is still high, at 305 per 100,000 live births. Several studies indicated maternal financial burden as one of the dimensions of access that influence a pregnant woman’s ability to receive adequate, high-quality medical care. This study aims to identify the association between the use of Indonesia’s national health insurance (JKN) and out-of-pocket (OOP) expenditures in accessing delivery services, using data from the Indonesian Family Life Survey 5. In addition, this study also investigated the relationship of JKN and the potential reduction of catastrophic delivery expenditures (CDEs) for delivery services. The results show that JKN was associated with reduced OOP expenditures for delivery as well as reduced risk of incurring CDE. However, some OOP expenditure for cost of delivery services still exists among mothers who used JKN during delivery, potentially due to factors such as medicine stock availability and inpatient care shortages.

Secondhand smoke exposure in Indonesia is high, especially compared to other Southeast Asian countries. Passive smoking leads to negative impacts on health and socio-economic well-being. Therefore, increasing the price of cigarettes and, thereby, increasing barriers to access to cigarettes could be an effective way to reduce smoking prevalence and protect people from second-hand smoke. This study aims to assess passive smokers’ support for cigarette price increases in Indonesia. We perform a quantitative analysis with a cross-sectional design. The data were obtained through phone-based interviews of 1000 respondents aged 18 and older in Indonesia. Only 596 nonsmokers were included to be further analyzed in this study. This study found that 44.1% respondents have at least one family member who smokes. We considered the respondents’ age, gender, education level, employment, and the number of people living in the respondent’s household that are exposed to passive smoking. Our results demonstrate that passive smokers support stronger tobacco control such as increasing cigarette prices, regulating smoking behavior using a religious approach (Fatwa), and applying more effective pictorial health warnings.

Background The current tobacco control policies in Indonesia are known to be ineffective in reducing tobacco consumption. Therefore, increasing cigarette prices is one of the effective instruments that should be supported by governments and society. This study aims to assess public support for cigarette price increases as well as to generate scientific evidence for the government and policymakers. Method This cross-sectional survey obtained data through telephone interviews with 1000 respondents aged ≥18 years old in Indonesia. The interviews started from 1 May 2018 to 31 May 2018. Result Respondents were varied in terms of age, gender, level of education, income, occupation, area of living and smoking status. This study found that 87.9% of the respondents including 80% of smokers support cigarette price increase to prevent children from buying cigarettes. Approximately 74.0% of smokers said they would stop smoking if cigarette prices were Rp70 000 (US$5) per package. The multivariate analysis revealed that age, income, money spent on cigarettes per day and the perception of current cigarette prices are the factors influencing support for higher cigarette prices. Conclusion The increase in cigarette prices is supported by society at large, including active smokers. The government must consistently adjust cigarette prices through an excise taxing and cigarette retail price mechanism. Governments, academicians, non-governmental organisations and tobacco control activists should generate a unified understanding that increasing cigarette prices will improve overall life quality.

Background: The sustainability of the National Health Insurance (NHI) program heavily relies on the premium of its member. The negligence of a large number of members at pay the premium lead to the failure of the Social Security Agency for Health (SSAH) to deliver its services. This study aims at analyzing important factors that influence the sustainability of premium payment of NHI's self-enrolled members in the Jakarta Greater Area. Design and methods: This study performed an econometric analysis from the panel and the same respondent's data in 2015 and 2017. The population of the study was NHI's self-enrolled members who lived in the City of Jakarta, Bogor, Depok, Tangerang, Bekasi, (Jakarta Greater Area) and it represents the urban area of Indonesia. The ordinal logistic regression model was used to determine the type of sustainability NHI premium payment. Results: The survey shows that around 28.3% of self-enrolled members do not pay the NHI insurance premium regularly. Applying ordered logit this study statistically confirms that age of household head, income per month, never experience economic hardship, 1^st/2^nd class registration, and benefits of SSAH are positively correlated with compliance rate to pay NHI insurance premium. Whereas tobacco consumption, health-seeking behavior, and the 2016 increase of premium are negatively correlated with regular premium payment. Conclusions: This study calls for policy intervention to improve compliance of premium payment such as i) massive promotion of insurance literacy and benefits of insurance through a health professional, internet, and government officer; ii) expanding auto-debit and installment premium payment; iii) incentive for paying premium regularly and not smoking; and iv) improving access and quality of health services.

Background: The incident of malignant cancer due to smoking habit becomes a public health problem especiallyin the developing countries. Active smokers neglect to stop smoking even though various studies proved that smokingincreases the risk of cancer. While, previous studies have assessed the incident risk of cancer but have not performed thevalidity of the measurement. The aim of this study is to know the number of cigarettes that contribute to the incidenceof malignant cancer. Methods: A study with retrospective cohort design has been conducted by using a set of publicdata of Indonesia Family Life Survey (IFLS) in 2007 and 2014. All active smokers (n= 748) who were in good healthcondition in 2007, were traced in 2014 and then being diagnosed with cancer with considering age, gender, healthyeating habit, and regular physical activity. Data has been analysed by using logistic regression by performing AdjustedRisk Ratio (ARR) and the result of validity measurement. Results: The incident of malignant cancer in 2014 were skin,liver, stomach and oral cavity. Smoking 21-30 per day in 2007 were significantly increased risk of having malignantcancer in 2014 at ARR: 6.88; SE:6.13 with the accuracy were 93.8%. The risk and accuracy were higher if smoke >30cigarettes per day (ARR:7.523; SE:7.019; accuracy 95.5%). This study also found that the risk of cancer was significantlyincrease with age (99% CI; ARR: 1.065; SE: 0.026). Conclusions: Cigarette smoking behaviour increased the risk anytypes incident of cancer. Total number >20 cigarettes smoked per day contributes to the incidence of malignant cancer.

Outpatient treatment is one of the benefits guaranteed by the National Health Insurance (JKN) program. The main objective of JKN program is to increase public accessibility to health services that suits their needs. Utilization of outpatient services are getting better by all levels of society is an indicator to the ideal image of the JKN program. The purpose of this study was to determine the pattern of outpatient health care at health facilities (physician practices/clinics, public health center, public and private hospitals) in the first year implementation of JKN program. This study used secondary data to analyze the data of Indonesia Family Life Survey (IFLS) in 2014 as the first year of implementation JKN program. The data in this study using a descriptive analysis which was deeply reviewed.The results showed that in the span of one year of JKN program implementation, the age population who get access to outpatient health care at the most in the range 0-18 years, the people of the urban areas more access outpatient health services compared to rural residences, and the population in the range of quintile (rich economic status) as much as 26.73%. Health facilities are the most widely used for outpatient services is physician practice or clinic amounted to 4.55%. The results of this study can be used as an evidence-based evaluation of the improvement of health care access for the public to pay more attention to the economic status of poor and be a proactive improvement of access to health services for people in rural areas. Abstrak Pelayanan rawat jalan merupakan salah satu manfaat yang dijamin oleh program Jaminan Kesehatan Nasional (JKN). Tujuan utama program JKN adalah meningkatkan aksesibiltas masyarakat terhadap pelayanan kesehatan yang sesuai dengan kebutuhan. Pemanfaatan layanan rawat jalan yang semakin baik oleh semua lapisan masyarakat merupakan gambaran ideal dan indikator tercapainya program JKN. Tujuan penelitian ini adalah untuk mengetahui pola pelayanan kesehatan rawat jalan pada fasilitas kesehatan (dokter praktik/klinik, puskesmas, RS pemerintah, dan swasta) di tahun pertama implementasi program JKN. Penelitian ini menggunakan data sekunder dengan menganalisis data Indonesia Family Life Survey (IFLS) 2014 sebagai tahun pertama implementasi program JKN. Teknik analisis dalam penelitian ini menggunakan analisis deskriptif yang diulas secara mendalam. Hasil penelitian menunjukkan bahwa pada rentang satu tahun implementasi program JKN, usia penduduk yang melakukan akses ke pelayanan kesehatan rawat jalan paling banyak pada rentang usia 0–18 tahun,masyarakat daerah perkotaan lebih banyak mengakses pelayanan kesehatan rawat jalan dibandingkan dengan penduduk pedesaan, dan penduduk pada kisaran kuintil 5 (status ekonomi kaya) sebanyak 26,73%. Fasilitas kesehatan yang paling banyak digunakan untuk layanan rawat jalan adalah dokter praktik/klinik sebesar 4,55%. Hasil penelitian ini dapat digunakan sebagai evidence based evaluasi perbaikan akses pelayanan kesehatan untuk lebih memperhatikan masyarakat berstatus ekonomi miskin dan jemput bola peningkatan akses pelayanan kesehatan bagi masyarakat di daerah pedesaan.