Healthcare access in Indonesia Patient values and ethical challenges

A decade ago, Indonesia introduced its national health insurance to improve healthcare access through protection from financial risks. However, challenges persist, particularly related to the need for more attention to the importance of patient values and ethical issues. To explore this topic, we conducted a systematic review, in-depth interviews, a quantitative analysis of national datasets, a conceptual analysis, and a case study. Patients' values are rarely studied in low and middle-income countries; we synthesize that patients' values can be categorized into values that are related to the patient, expectations from the provider, provider-patient interaction, and the primary health care system. Patients could benefit from the implementation of personal continuity of care. The physical layout and environment of primary healthcare facilities affect patient privacy and quality of care. The standard practice of closing consultation room doors. Then, we analysed the traditional Javanese value of 'nrima', which means acceptance, and its implications for the patient-doctor relationship. We found that inequalities in the healthcare supply side posed a challenge to the use of national health insurance. There are drawbacks of hierarchy to the quality of care. Improvements that focus on the supply side are insufficient, and finally, it is important to pay more attention to daily ethics and values in medical practice.