Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Mar 11, 2025
Date Accepted: Sep 18, 2025
Differences in Hemodialysis Claim Patterns Across Membership Types Among Renal Failure Patients in Indonesia: Cross-sectional Analysis of National Health Insurance Data (2017–2022)
ABSTRACT
Background:
Kidney diseases are leading causes of morbidity and mortality globally and in Indonesia. Despite expanded national health insurance coverage, disparities in hemodialysis access remain
Objective:
Our study aims to examine disparities in hemodialysis utilization among renal failure patients
Methods:
A cross-sectional analysis was conducted using 38,383 renal failure claims from BPJS Kesehatan from 2017 to 2022. Multivariate logistic regression models examined associations between hemodialysis access and BPJS membership types, demographic characteristics, and health system factors. Subgroup analyses by sex, facility ownership, urbanicity, and region were also performed.
Results:
Hemodialysis was provided in 75.6% of claims. Subsidized members funded by the national budget (PBI APBN) had significantly lower odds of receiving hemodialysis compared to informal workers (PBPU) and members subsidized by local budgets (PBI APBD), with adjusted odds ratios (AORs) of 1.56 and 1.31, respectively. Disparities were more pronounced in rural areas, where PBI APBD members had higher odds (AOR 2.40) than their PBI APBN counterparts. Patients in private facilities (AOR 1.30) and urban areas had better access, while regional disparities favored developed regions like Java/Bali.
Conclusions:
Addressing systemic inequities in Indonesia’s health system is critical to improving hemodialysis access and advancing universal health coverage.
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