Correlation between economic status and severity of type 2 diabetes mellitus in Indonesia: analysis of claim data from the national health insurance scheme, 2018-2022.

Abstract

This study investigated the correlation between the type of health insurance membership as a proxy for the economic status of patients and the severity of their type two diabetes mellitus (T2DM) in Indonesia. The study conducted a secondary analysis of National Health Insurance (Jaminan Kesehatan Nasional) claim data provided by the Indonesian Social Security Agency, <i>Badan Penyelenggara Jaminan Sosial</i> (BPJS). We used ordered logistic regression with four severity levels for T2DM (0=outpatient, I=mild, II=moderate, III=severe) as dependent variables. The main independent variables (insurance membership categories) included subsidised insurance members (PBI), a combination of formally employed and nonsalaried informal workers (PBPU & PPU) and nonworkers (BP). Secondary healthcare facilities in Indonesia. The dataset included 2 989 618 claims for hospital visits of people with T2DM from 2018 to 2022. Severity level of T2DM patients. A higher percentage of T2DM patients who visited healthcare facilities with subsidised insurance (PBI), which represents a low-income group, have severe disease (6.9%) than patients in the PBPU & PPU (4.9%) and BP categories (5.5%). Moreover, regression analysis revealed that having PBI membership status was associated with a greater OR of having severe T2DM than nonsubsidised members. Among T2DM patients in the nonsubsidised insurance category, workers (PBPU & PPU) had an OR of 0.74 (95% CI: 0.735 to 0.745; p<0.0001) for having severe disease during hospital visits. Moreover, non-workers (BP) had a lower OR of 0.718 (95% CI: 0.711 to 0.725; p<0.0001) for severe disease than the PBI category. These findings illustrate the lack of optimal access to health services for diabetes patients in low-income insurance membership categories and the challenges of better treatment in health facilities for low-income patients.