In the pursuit of universal access Inequalities in healthcare utilisation in Indonesia

Inequalities in the use of healthcare are a major global health issue, affecting both high-income countries and low- and middle-income countries (LMICs). Indonesia is one of the largest LMICs in the world and it has a very heterogeneous population in terms of demographic backgrounds. It thus has all the ingredients to experience significant inequalities in healthcare utilisation. However, no studies have comprehensively assessed socioeconomic inequalities in healthcare utilisation in detail for the Indonesian adult population as a whole. This thesis is aimed to describe the scale of socioeconomic and geographical inequalities in healthcare access in Indonesia and to identify factors that might contribute to such inequalities. Our studies showed that although inequalities in healthcare utilisation have decreased in Indonesia during the past two decades, considerable disparities within secondary care and preventive care still exist, both between socioeconomic groups and between geographical districts. It appears likely that the inequalities are related to dynamic interactions between demand-side and supply-side factors that govern people’s use of healthcare. These include an inadequate supply of secondary services, underperformance in the primary care system, complicated referral procedures, geographical variations in the price and responsiveness of services, and possible influences from government decentralisation. To reduce inequalities in healthcare utilisation in Indonesiam we recommend to improve the adequacy and distribution of secondary care in rural and remote areas, strengthen the primary care system, expand the coverage of national health insurance to the informal sector, and simplyfing the referral system to reduce unnecessary barriers for low socioeconomic groups.