Expanding national health insurance coverage in Indonesia’s remote areas: who should be prioritized?

Abstract

Introduction: The objective of this study was to ascertain the target population for expanding National Health Insurance (NHI) coverage in remote areas of Indonesia. Methods: This study used secondary data for 130,331 people from the 2023 National Socio-economic Survey, a nationally representative cross-sectional household survey conducted by Indonesian Statistics. NHI membership was used as a dependent variable. The study examined residence, age, gender, marital status, education, and occupation as independent variables. In the last phase, binary logistic regression was used. Results: The NHI membership rate in disadvantaged regions of Indonesia was 74.5%. People in rural areas were 1.11 times more likely to be NHI members than those in non-rural areas (95%CI 1.06–1.16). Age was related to NHI membership. Married people were 1.29 times more likely than those never married to be NHI members (95%CI 1.25–1.34). Divorced/widowed people were 1.16 times more likely than those never married to be NHI members (95%CI 1.08–1.23). People at all other education levels than primary school education were more likely to be NHI members. Employed people were 1.36 times more likely to be NHI members than those who were unemployed (95%CI 1.31–1.40). The wealthier the people, the higher the likelihood of them being NHI members.Conclusion: Based on the study's results, the target population includes non-rural residents in disadvantaged regions as well as never-married individuals, those with primary education or less, those who are unemployed, and the poorest wealth quintile, requiring interventions like mobile enrolment units and simplified registration protocols.