Health Insurance Membership Among Parous Women in Indonesia: Are There Rural/Urban Differences?

Abstract

With the relatively high maternal mortality and morbidity in Indonesia, reproductive women become the main target for universal health coverage (UHC). Particularly, to increase insurance membership and maternal healthcare utilization. In Indonesia, the sociodemographic diversities signifies the importance of understanding the insurance membership barriers within different areas. This paper aims to assess differences in health insurance membership between rural and urban areas in Indonesia.

We used the Indonesian Demographic Health Survey (IDHS) 2012 data, a cross-sectional nationally representative survey. We included data from 12,692 women who completed the insurance membership questionnaire and gave births during five years of the survey. Weighted Chi-Square and mixed effects logistic regression were conducted to assess differences of insurance membership by sociodemographic factors in rural and/or urban areas of Indonesia.

We found that there were differences in health insurance membership between rural and urban women. Urban women had a significantly higher proportion (42.0%) of membership compared to rural women (31.9%). There was a larger economic disparity in urban areas with a J-shape curve. Women of lowest and highest family wealth have a higher proportion of insurance membership compared to women in the middle wealth groups. Although significant, this economic disparity was less drastic in rural areas. Women who were older, have more parity, of lower socioeconomic status (SES). In general, women with higher education level were more likely to have insurance membership.

In conclusion, health insurance membership was different between rural and urban women. Although we observed similar sociodemographic determinants of health insurance membership, there were differences in the disparity and effect of these determinants on health insurance membership. Further work should focus on developing the more effective and specific intervention to achieve UHC in rural and urban areas of Indonesia.