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Disability-based disparities under universal health coverage among chronically ill adults during the COVID-19 pandemic in Indonesia: an interrupted time series analysis

Year: 2025

Type: article

Abstract: BACKGROUND: People with disabilities (PWD) face persistent barriers to healthcare, often exacerbated during public health emergencies. In Indonesia, 10.8% of adults with disabilities have chronic disease, yet how the National Health Insurance (JKN) addresses disparities remains unclear. OBJECTIVE: To assess the COVID-19 pandemic's impact on disability-based disparities in chronic healthcare utilization under JKN, and whether these were modified by gender or geographic disadvantage. METHODS: A panel-based interrupted time series analysis using generalized estimating equations was conducted on the JKN sample dataset (1% of national enrollees). The sample included 108,762 adults aged 19-65 with chronic conditions, with monthly primary care records from September 2019 to August 2020. Outcomes were preventive and curative visits, modeled by disability status, gender, and residence district. RESULTS: The sample averaged 48.3 years, 61.2% were women, 15.5% had a disability, and 1.2% lived in underdeveloped districts. Preventive visits declined 25.6% and curative visits 40.5% in the first two months of the pandemic. PWD had higher curative care use (IRR = 1.05; 95% CI: 1.02-1.07), but women with disabilities had fewer curative visits than men with disabilities (IRR = 0.92; 95% CI: 0.86-0.98). Residence in underdeveloped districts reduced preventive (IRR = 0.34; 95% CI: 0.19-0.60) and curative (IRR = 0.83; 95% CI: 0.70-0.99) visits. CONCLUSIONS: The pandemic worsened disparities. Gender compounded disability-related inequities in curative use, while geographic disadvantage limited access for all. Future research should examine longer-term trends. Integrating disability- and gender-inclusivetuy approaches is essential for equitable UHC during and beyond crises.

Source: Global Health Action

DOI: 10.1080/16549716.2025.2581946

Authors: Nuzulul Kusuma Putri, Robeth Jabbar Syahansyah

Institutions: Tulane University, Universitas Airlangga, Universitas Dr. Soetomo

Language: English

Topic: COVID-19 and healthcare impacts

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $1,509