Do justice and trust affect acceptability of Indonesian social health insurance policy?

Abstract
Purpose – The purpose of this paper is to investigate whether justice, trust in healthcare services, the confidence level of the health system and institutions, political party support and evaluation of healthcare services post-Jaminan Kesehatan Nasional ( JKN) affected policy acceptability (PA) in the health workers (n¼95) and laypeople (n¼308) sample.
Design/methodology/approach – The authors performed a two-level, linear mixed-effects model to test the hypothesis that trust, perceived justice, confidence in healthcare services and national health system evaluation could impact PA in the health workers and laypeople sample. The authors calculated the effect sizes by comparing Level 2 variances and residuals of the null model and the random intercept model.
Findings – The findings suggested that healthcare workers with high concern for justice would be more likely to hold negative acceptability to JKN. The findings implied that health workers tend to associate JKN with unfairness. Also, JKN acceptability in laypeople sample was found to be positively associated with the evaluation of healthcare service post-JKN, whereas justice or political party support did not affect JKN acceptability. It might indicate that laypeople motives for joining JKN scheme could be essentially pragmatic.
Research limitations/implications – The authors administered the questionnaire using an online platform and circulated it through social media and IMS, so that this research poses a problem of self-selection bias, which potentially leads to biased estimates. The authors also oversampled female participants, especially in laypeople sample.
Originality/value – Aiming at universal health coverage in 2019, JKN will cover almost 300m Indonesians and be one of the biggest single-payer national health insurance scheme in the world. The research might offer insight into how health workers and laypeople respond to the policy.
Keywords- Health policy, Patient perspectives, Quantitative research, Public health regulations,
Determinants of health, Health insurance plans

Journal
Zein, R., Putri, N. and Ridlo, I. (2019), “Do justice and trust affect acceptability of Indonesian social health insurance policy?”, International Journal of Health Governance, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IJHG-05-2019-0028

Pre-Print
Has supplemental materials for Do Justice and Trust Affect Acceptability of Indonesian Social Health Insurance Policy? A cross-sectional survey of laypeople and health care workers on INA-Rxiv at https://doi.org/10.31227/osf.io/fvtjg

Transparency
All data generated or analysed during the current study are available at https://osf.io/gsd5t/

Acknowledgements
No competing interest is declared by the authors. Universitas Airlangga funded this study under University Research Grant Scheme (Grant No. 886/UN3/2018). The research was conducted in accordance with Helsinki Declaration and Indonesian Psychological Association Code of Conduct (2010); however, observational studies are typically not required for ethical clearance in Universitas Airlangga. Before participating, the authors gave prospective participants detailed information about the study and the opportunity to raise questions. Before the participants proceeded to the questionnaire pages, they were required to give consent by clicking on “I agree” button.

Riset: iklan rokok kepung sepertiga sekolah di Surabaya, kenapa Risma tidak melarangnya?

Siswa di warung dekat sekolah yang dipasangi iklan rokok di Kota Surabaya.
Author provided

Ilham Akhsanu Ridlo, Universitas Airlangga; Dian Kusuma, Imperial College London, dan Hario Megatsari, Universitas Airlangga

Hampir sepertiga sekolah dasar dan menengah pertama di Kota Surabaya dikepung oleh ratusan iklan rokok luar ruang. Tanpa peraturan larangan iklan rokok di tepi jalan-jalan utama dan dekat sekolah, wajah Kota Pahlawan akan terus disesaki oleh promosi produk yang merusak kesehatan penduduk tersebut.

Riset terbaru kami membuktikan bahwa mudah sekali melihat dan menemukan iklan rokok di luar ruang di sekitar lembaga pendidikan, mulai dari sekolah dasar hingga universitas, di Kota Surabaya. Hampir 30% dari 1199 sekolah negeri dan swasta di kota ini masing-masing terpapar setidaknya oleh satu iklan rokok di lingkungannya. Sekitar 300 meter dari sekolah atau 10 menit dari sekolah, mudah ditemukan papan reklame rokok. Dua pertiga universitas juga “diserbu” oleh iklan tembakau di ruang terbuka.

Wali Kota Surabaya Tri Rismaharini mestinya lebih maju langkahnya dalam melindungi warganya dari paparan iklan tembakau, terutama anak-anak di sekolah, yang mungkin memandang rokok sebagai produk normal seperti teh kemasan. Padahal, jelas bahwa rokok adalah produk tidak normal dan berbahaya baik secara kesehatan, lingkungan, maupun ekonomi keluarga. Iklan rokok adalah cara industri tembakau untuk “menormalisasi” perilaku merokok dan menggaet perokok baru.

Walau Kota Surabaya mempunyai Peraturan Daerah Kawasan Tanpa Rokok (KTR) sejak 2008 dan diperbarui tahun ini, regulasi ini tidak melarang iklan rokok di luar ruangan. Melihat kepungan iklan rokok di kawasan sekolah tersebut, maka potensi adanya peningkatan perokok pemula perlu diperhatikan oleh pemerintah Kota Surabaya.

Perusahaan rokok bebas beriklan

Indonesia adalah salah satu kontributor utama jumlah perokok di dunia dengan lebih dari 60 juta perokok pada 2018. Riset Kesehatan Dasar 2018 menunjukkan prevalensi merokok di kalangan remaja (10-18 tahun) meningkat sebesar 1,9% (7,2% menjadi 9,1% selama 2013-2018).

Salah satu pemicunya adalah promosi yang agresif melalui iklan di luar ruang. Studi kami menjelaskan posisi geografis dan jarak pandang iklan rokok luar ruang di sekitar sekolah dan universitas di Kota Surabaya. Kami memakai analisis geospasial dengan radius 100 dan 300 meter dan hotspot analysis (daerah yang memiliki kepadatan iklan lebih tinggi).

Data lokasi iklan rokok ukuran besar dan sedang dikumpulkan pada Oktober-November 2018 dengan mensurvei 250 ruas jalan yang boleh dipasangi reklame seperti ditetapkan dalam Peraturan Wali Kota No. 70 Tahun 2010. Data geocode kami ambil dengan menggunakan aplikasi mobilephone dan dibantu dengan ArcMap 10.6.

Kami menemukan 307 iklan rokok di jalur-jalur tersebut yang meliputi billboard (63%), banner (31%), dan videoboard (7%). Sebagian besar iklan (89%) dimiliki oleh tiga perusahaan terbesar: PT. Djarum (38%) dan PT. Gudang Garam (24%) dan PT HM Sampoerna (Phillip Morris) (27%). Sisanya, 11 persen, milik PT. Bentoel International, PT. Wismilak, PT. Kayadibya Mahardika (Apache), PT Kolang Citra Abadi (Moden), dan PT. Nojorono Tobacco (Minak Djinggo/Class Mild).

Iklan tersebut dipasang di seluruh kota dengan beberapa terkonsentrasi secara strategis di bagian pusat kota (Surabaya tengah). Kami bandingankan data lokasi iklan itu dengan data lokasi sekolah dan universitas negeri dan swasta di kota ini.

Dari data ini tampak ada potensi paparan iklan rokok pada ratusan ribu anak-anak usia sekolah (ada sekitar 470 ribu siswa berusia 5-19 tahun di Kota Surabaya). Dalam hal intensitas iklan, ada 239 iklan rokok (78% dari total) berada dalam jarak 300 meter dan dapat ditempuh dengan berjalan kaki 10 menit dari sekolah. Iklan mereka paling banyak ditemui di lingkungan sekitar sekolah swasta dan sekolah dasar dan sekolah menengah. Dua pertiga universitas berada di dalam hotspot iklan rokok.

Tingginya visibilitas iklan rokok luar ruang di sekitar fasilitas pendidikan terjadi karena di kota ini tak ada larangan promosi rokok di ruang terbuka. Banyak dari promosi tersebut adalah papan iklan dan papan video besar, yang pesannya lebih mudah diingat orang muda.

Dari data tersebut tampak bahwa tiga perusahaan tembakau terbesar (Djarum, Gudang Garam, dan Sampoerna) memasarkan rokok secara agresif dan menarik, terutama kepada kaum muda. Semua ini mendorong citra merek yang ada dalam materi iklan dan meningkatkan potensi penggunaan tembakau di kalangan muda.

Hasil riset ini juga menunjukkan titik pusat (hotspot) iklan yang signifikan, terutama di daerah tengah kota yang terlihat lebih padat penduduknya dan lebih miskin. Ini dapat berkontribusi pada meningkatnya penggunaan tembakau di antara populasi yang lebih miskin, khususnya kaum muda.

Lemahnya pengendalian tembakau

Pemerintah Indonesia begitu lemah mengendalikan tembakau, termasuk tidak ada larangan iklan rokok di luar ruang secara nasional. Padahal, banyak negara telah memberlakukan larangan nasional terhadap iklan tembakau luar ruang termasuk Amerika Serikat (sejak 1998), Inggris (sejak 2003), dan Sri Lanka (sejak 2006).

Di tingkat daerah, beberapa kabupaten telah melarang iklan rokok di luar ruang tapi masih menemui kendala implementasi. Contohnya, Kabupaten Banyuwangi memberlakukan larangan iklan rokok di jalan utama dan arena olahraga pada 2016, tapi survei menemukan sekitar 1.300 iklan rokok setahun kemudian.

Riset kami bertujuan untuk memberikan bukti tentang visibilitas iklan rokok luar ruangan di sekitar fasilitas pendidikan di Kota Surabaya yang tidak memiliki peraturan larangan.

Hasil riset ini mendukung peran penting regulasi yang melarang iklan rokok luar ruang dalam mengurangi paparan pemasaran rokok, khususnya bagi kaum muda. Bukti ini seharusnya dapat mengingatkan pemerintah untuk melarang iklan tembakau luar ruangan.

Idealnya iklan rokok di luar ruang dilarang total untuk menghentikan tren peningkatan prevalensi merokok di kalangan kaum muda.

Belajar dari daerah lain

Saat ini, hanya sekitar 3% kabupaten dan kota di Indonesia yang memiliki beberapa peraturan untuk melarang iklan tembakau luar ruangan. Upaya terpadu harus dilakukan untuk meluaskan pelarangan iklan rokok di ruang terbuka ke 97% kabupaten lainnya.

Rujukan paling memadai larangan iklan rokok di ruang publik adalah DKI Jakarta (sejak 2015), Kota Bogor (sejak 2015) dan Kulonprogo (sejak 2014). Pengalaman daerah tanpa iklan di Indonesia tersebut dapat dijadikan acuan berbagai kota lainnya, bahwa iklan rokok bukan satu-satunya sumber Pendapatan Asli Daerah (PAD).

Roda pemerintahan daerah yang melarang iklan rokok di luar ruang itu tetap berjalan normal. Ruang iklan yang dulu dibeli oleh perusahaan rokok kini tergantikan oleh produk lain non-tembakau seperti telekomunikasi, aplikasi transportasi, perbankan, dan produk lainnya.

Dengan temuan riset ini, kami sangat berharap Wali Kota Surabaya Tri Rismaharini segera melarang total iklan rokok luar ruang untuk melindungi anak-anak dari paparan promosi rokok di Kota Pahlawan.The Conversation

Ilham Akhsanu Ridlo, Lecturer in Department of Health Policy and Administration, Universitas Airlangga; Dian Kusuma, Research associate, Imperial College London, dan Hario Megatsari, Lecturer in Public Health, Universitas Airlangga

Artikel ini terbit pertama kali di The Conversation. Baca artikel sumber.

Distribution Analysis of Doctors in Indonesia

Introduction:
The distribution of health workers was an important study in Indonesia which has a wide geographical range and challenges as an archipelagic country for the fulfillment of fair and equitable health services. Aim: The study was conducted to answer factors related to the distribution of doctors based on provinces in Indonesia.
Methods:
Advanced analysis of secondary data from “Data and Information: Indonesian Health Profile in 2017”. The analysis unit in this study was the province, all 34 provinces in Indonesia were analyzed. The dependent variable was the Number of Doctors. Dependent variables were the number of population, density, percentage of poor people, number of hospitals, and number of Puskesmas.
Results:
Variability in the availability of doctors was very wide. The more the population, the more attractive it was for doctors to practice in the province. The denser the population, the more attractive it was for doctors to practice in the province. The more the poor population, the more attractive it was for doctors to practice in the province. The more hospitals, the more attractive it was for doctors to practice in the province. The more Puskesmas, the more attractive it was for doctors to practice in the province. Conclusions:
All variables analyzed were related to the number of doctors. Variables of population, density, percentage of poor people, number of hospitals, and number of Puskesmas were positively related to the number of doctors.

Available on INA-Rxiv Pre-Print: https://osf.io/preprints/inarxiv/df6ns/

Citation:
APA
Laksono, A. D., Ridlo, I. A., & e. (2019, June 18). Distribution Analysis of Doctors in Indonesia. https://doi.org/10.31227/osf.io/df6ns
MLA
Laksono, Agung D., et al. “Distribution Analysis of Doctors in Indonesia.” INA-Rxiv, 18 June 2019. Web.
Chicago
Laksono, Agung D., Ilham A. Ridlo, and ernawaty. 2019. “Distribution Analysis of Doctors in Indonesia.” INA-Rxiv. June 18. doi:10.31227/osf.io/df6ns.

Gambaran Prevalensi Balita Stunting dan Faktor yang Berkaitan di Indonesia: Analisis Lanjut Profil Kesehatan Indonesia Tahun 2017

ABSTRAK.

Hasil Riskesdas tahun 2007, 2013 dan 2018 menunjukan angka stunting pada balita masih di atas 30%. Sementara kemiskinan dibuktikan seringkali hadir bersamaan dengan terjadinya stunting pada balita. Gizi yang adekuat pada masa hamil dan pengawasan kesehatan ibu hamil melalui pelayanan antenatal care dinilai merupakan salah satu upaya sensitif dalam penanggulangan stunting. Studi ini ditujukan untuk menjawab apakah faktor kemiskinan dan ketersediaan layanan kesehatan berhubungan dengan prevalensi balita stunting di provinsi di Indonesia. Penelitian ini merupakan analisis lanjut data sekunder “Data dan Informasi: Profil Kesehatan Indonesia tahun 2017”. Data dianalisis secara deskriptif dengan tabulasi silang. Hasil penelitian menunjukkan bahwa pada kategori persentase penduduk miskin yang tinggi (> 14,43%) didominasi oleh prevalensi balita stunting yang tinggi (22,51%-30,0%). Pada kategori rasio Puskesmas per 100 ribu penduduk tinggi (≥ 4) terlihat didominasi oleh prevalensi balita stunting pada kategori tinggi (22,51%-30,0%). Pada kategori rasio tenaga gizi per 100 ribu penduduk tinggi (> 12) justru terlihat didominasi oleh prevalensi balita stunting kategori tinggi (22,51%-30,0%). Pada kategori rasio tenaga bidan per 100 ribu penduduk tinggi (> 97) didominasi oleh prevalensi balita stunting kategori tinggi (22,51%-30,0%). Disimpulkan bahwa persentase penduduk miskin berhubungan secara positif dengan prevalensi balita stunting. Sementara faktor input pelayanan kesehatan (Puskesmas, tenaga gizi, dan tenaga bidan) tidak berhubungan dengan prevalensi balita stunting. Disarankan pemerintah lebih memfokuskan sasaran kebijakan pada masyarakat miskin.

Kata Kunci: balita, stunting, profil kesehatan, kemiskinan

https://www.researchgate.net/publication/331908237_Gambaran_Prevalensi_Balita_Stunting_dan_Faktor_yang_Berkaitan_di_Indonesia_Analisis_Lanjut_Profil_Kesehatan_Indonesia_Tahun_2017

Laksono, Agung & Kusrini, Ina. (2019). Gambaran Prevalensi Balita Stunting dan Faktor yang Berkaitan di Indonesia: Analisis Lanjut Profil Kesehatan Indonesia Tahun 2017. 10.13140/RG.2.2.35448.70401. 

#CondomEmoji: Are urban Indonesians receptive to a social media-based campaign for safer sex?

Abstract Purpose
The purpose of this paper is to explore participants’ attitudes and receptivity to a #CondomEmoji campaign insofar as investigating whether attitudes and receptivity were important predictors for brand impression and intention to buy. Design/methodology/approach – This study involved 206 research participants who live in Jakarta and Surabaya and who answered online questionnaires to measure attitudes, receptivity to #CondomEmoji advertising, brand impression and intention to buy condoms. Questionnaires were circulated on several social media platforms and instant messaging apps. The participants were asked to watch the #CondomEmoji advertising video before proceeding to fill out the questionnaires. Findings – Research findings suggested that participants mostly held negative attitudes and receptivity to the campaign. Non-sexually active participants were more likely to perceive the advertising as offensive. Attitudes and receptivity were good predictors for brand impression, yet attitude was not significantly attributed to intention to buy condoms. The result was stronger in sexually active participants. Research limitations/implications – Non-sexually active young people need to be more informed about healthy sexual behavior so that they would not feel embarrassed to discuss and ask about sexual behavior. A socially acceptable condom-use advertising campaign needs to be conducted to lessen the resistance of conservative audiences.
Originality/value
This paper offers an insight into how conservative audiences may respond to social-media-based campaign of safer sex.
Keywords: Social marketing, Attitudes, Health media
Paper type: Research paper

The Changing Nature of CampusHealth Insurance: Testing Portability Issues of National Health Insurance

Abstract:
Before National Health Insurance was implemented, the majority of leading universities in Indonesia already covered their studentswith a health insurance scheme. They managed their own campus health insurance independently. Both National Health Insurance in 2014 and single tuition policy in 2015 brought huge change to campus health insurance. This study aims to analyse students’ needsin health insurance after implementation of these policies. This is an exploratory study with cross-sectional design. The sample was taken by voluntary sample through online questionnaire. There were 83 students across different academic degree participated in this study. Most of the students (65.1%) came from various districts outside the campus district and chose to reside in boarder houses around the campus. There were only 52.9% of the students already listed as National Health Insurance participants. Out-of-pocket risk belongs to 35.5% students who were not covered by health insurance at all. Almost all of the students who already participated in National Health Insurance (93.3%) were registered in the primary healthcare in their hometown. The students are already paying for single tuition which does not accommodate health insurance. A real changing need of migrant students for health insurance coverage exists in the National Health Insurance era. 1INTRODUCTIONUniversal Health Coverage swept many countries in the last decade, including Indonesia. Even though Indonesia is the biggest archipelago country with a widely dispersed territory, National Health Insurance is chosen as the health insurance mechanism ratherthan region-based insurance. This decision has consequences in the portability challenges of the preferred health insurance scheme. Previous region-based health insurance mechanisms already implemented by local government should be merged into a national scheme. It should enable not only raising the poolinglevel in local government, but also maintaining the cross-regional participation transfer (Pan et al., 2016).Previously, the majority of universities in Indonesia had institutionally managed health services for their students before the enactment of the National Health Insurance. The provision of this health service is funded through a student health insurance scheme that is managed independently by the university and which is limited only for students in the university. Student health insurance is regulated through the policy of each rector. Generally, this fund pooling is collected through a semi-annual contribution in addition to the tuition fee. These funds are managed to finance the health of students during their education. However, in accordance with the mandate of the Ministry of Education, universities are not permitted to collect additional fees outside the national rate. However, the calculation of this national rate does not accommodatestudent healthcare insurance. The National Health Insurance that was launched one year previously also makes this situation more complicated. The availability of parental health insurance can have significant effects on the probability that a young individual enrols as a full-time student in university (Jung et al., 2013). Unfortunately, there is no individual student membership in National Health Insurance. To be able to be covered by National HealthInsurance, students should be registered with all of their family members. The huge variations of health insurance mechanisms bring many obstacles to the citizens who wish to temporarily move to another region for some years. In Indonesia, young adults from rural regions who have just graduated from senior high

Putri, N. and Ernawaty, .The Changing Nature of Campus Health Insurance: Testing Portability Issues of National Health Insurance.InProceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 14-19ISBN: 978-989-758-335-3Copyright©2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved Mark as interesting Comment Delete highlight
(1) (PDF) The Changing Nature of Campus Health Insurance: Testing Portability Issues of National Health Insurance. Available from: https://www.researchgate.net/publication/329217279_The_Changing_Nature_of_Campus_Health_Insurance_Testing_Portability_Issues_of_National_Health_Insurance [accessed Mar 30 2019].

Protecting those who care: The characteristics of occupational Tuberculosis risk in health care workers

Nosocomial TB infection remains an urgent public health problem that requires relentless efforts to overcome. In general, health care workers (HCWs) have a significantly higher risk of suffering from active and latent TB owing to their daily occupational TB risk exposure. The risk is indeed more severe in high TB burden countries, such as Indonesia. In this research, we aimed to: (1) investigate the underlying factor structure of risk characteristics, specifically the risk of nosocomial TB transmission in health care facilities; (2) estimate the effects of work-related determinants and risk characteristics on risk perception; and (3) compare occupational risk perception of contracting TB with expert risk assessment. A paper-based questionnaire was administered to 179 HCWs working for ten public health centres and two hospitals in Surabaya, Indonesia. An exploratory factor analysis of nine risk characteristics revealed a two-factor solution (knowledge-evoked dread and controllability of damage). Structural equation modelling indicated a piece of suggestive evidence that controllability of damage positively affected risk perception, while knowledge-evoked dread did not. Perceived safety conditions yielded a positive and moderate association to controllability of damage, implying that safety infrastructure could be perceived as ‘a cue’ to the presence of a dangerous hazard. The intensity of exposure to TB patients was negatively correlated with the controllability of damage. This indicates that more experience in handling TB patients could lead to underestimation of risk. Our research showed that HCWs tended to accurately estimate the risk of contracting TB based on their specific profession/duties, yet overestimated the risk of contracting TB when it was aggregated to the health care facility level. Although further research is necessary, to include the prevalence of latent/active TB as a part of risk assessments, our research highlights the importance of addressing risk perception, especially encouraging HCWs to become more active in advocating for the required allocation resources for their workplaces or even aiding in raising communities’ awareness of TB transmission.

Urban and rural disparities in hospital utilization among Indonesian adults

Background:
Equal access to healthcare facilities, patient’s satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas. Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was de-signed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests. Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 – 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 – 1.255). While for the category of hospital inpatient utilization, there was no significant difference. Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care.

Do Justice and Trust Affect Acceptability of Indonesian Social Health Insurance Policy? A cross-sectional survey of laypeople and health care workers

Abstract
After two bills passed in 2004 and 2011, a nation-wide social insurance in Indonesia has formally established. Aiming at a universal health coverage in 2019, the Jaminan Kesehatan Nasional (JKN) will cover almost 260 million Indonesians and be one of the biggest single payer national health insurance scheme in the world. Our research attempted to investigate whether justice, trust to health care services, confidence level of health system, political party support and evaluation of health care services post-JKN affected policy acceptability in our health workers (N=95) and laypeople (N=308) sample. A-two level multilevel modelling in our health worker sample revealed that justice negatively correlated to policy acceptability, while confidence to health system and institutions as well as evaluation of health care service post-JKN yielded positive correlation. In our laypeople sample, trust to health care service and evaluation of health care service post-JKN were positively affected policy acceptability. In this paper, we discussed why justice matters to a positive policy acceptability for health workers, but not for laypeople. We also discussed the possibility of laypeople’s pragmatic motives of joining JKN scheme.