Clinical Outcomes among Type 2 Diabetes Mellitus Patients: Before and after Universal Health Coverage in Indonesia
Objective: This study was carried out to analyze the impact of universal health coverage in Indonesia, known as Jaminan Kesehatan Nasional (JKN) on percentage of patients who did fasting blood glucose (FBG) tests each hospital visit and clinical outcomes (CO) in type 2 diabetes mellitus (T2DM) patients.
Methods: We conducted a longitudinal retrospective study to collect the data from 6-month before JKN and 1-year after JKN at 3 hospitals in Jakarta Province. All T2DM outpatientsâ€™ services using Asuransi Kesehatan (ASKES) with at least 6 hospital visits were included. The subject with double insurances and died before implementation of JKN were excluded. The clinical outcome before and after JKN were compared with Wilcoxon test.
Results: Total samples that collected were 296 patients divided to predominance female with 166(56%) and male 125(44%). From the data, it seemed that there were no all patients who did FBG test. We founded 50% of patients had FBG test before JKN.Â Meanwhile, the percentage at the beginning of JKN tended to be lower about 37% than before JKN. Number of patiens decreased associate with JKN but number of hospital visit increased. Based on FBG level, 17(9.19%) patients had better CO and this number increased slightly after JKN to 22(11.89%). In contrast, patients with worse FBG level decreased about 9%. More patients had bad stable and less patients had good stable FBG level. Statistical analysis showed that CO between before and after JKN had P value 0.404 among T2DM outpatients in Type A Hospitals and P value 0.877 in Type B Hospital.
Conclusion: Implementation of JKN had impact to decrease percentage of patients who did FBG tests and number of patients but raised hospital visit. CO was different significantly between before and after JKN among T2DM outpatients in Type A Hospitals but was no different in Type B Hospital.
2. Ministry of Health the Republic of Indonesia Decree no. 27 year 2014. Technical instruction of INA-CBGs. Jakarta; 2014.
3. Ministry of Health the Republic of Indonesia Decree no. 59 year 2014. Tariff standard of health services in implementation of national health insurance. Jakarta; 2014.
4. IDF Diabetes Atlas, 5th edition. International Diabetes Federation, Updated 2012.
5. National health survey (RISKESDAS). Central data and information Ministry of Health The Republic of Indonesia. Jakarta; 2014.
6. Restinia M, Anggriani Y, Kusumaeni T, Meryta A. Drug treatment profile among outpatients of type 2 diabetes mellitus after implemented of JKN. Jifi 2015;13:63-8.
7. Wilson SE, Rosella LC, Lipscombe LL, Manuel DG. The effectiveness and efficiency of diabetes screening in Ontario, Canada: a population-based cohort study. BMC Public Health 2010;10(1):1-12.
8. National health survey (RISKESDAS). Central data and information Ministry of Health The Republic of Indonesia. Jakarta; 2013.
9. PÃ¡gan JA, Puig A. Differences in access to health care services between insuredand uninsured adults with diabetes in Mexico. Diabetes Care 2005;28(2):2.
10. Association Diabetic American. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37(1):S14-27.
11. Ministry of Health the Republic of Indonesia Decree no 32/1/2014. Health service on BPJSâ€™s members in primary and advanced health care facilities. Jakarta; 2014.
12. Regulation of Ministry of Health the Republic of Indonesia no 28 year 2014. Guideline implementation of JKN. Jakarta; 2014
13. Ali FA. Analysis of refer back program implementation in primary health care and facilities among member of JKN in Siko and Kalumata Kota Ternate Puskesmas year 2014. JIKMU 2015;5(3).
14. Purwarti EII. Decision makingby Puskesmas in implementation of refer back program as primary health care and facilities. Skripsi.2016. University of Jember.
15. Trisnawati K, Sumarni S, Fudholi A. Analysis of outpatient satisfaction for civil servant during the implementation of ASKES and JKN. JMPF 2015;5(1):33-9.
16. Nugraheni G, Putri LR, Setiawan CD, &Wijaya IN. BPJS patients satisfaction to quality of pharmacy services in health center (analysis using SERVQUAL model and customer window quadrant. Proceeding IAI 2016;e-ISSN: 2541-0474.
17. BPJS decree no 38 year 2014. Technical instruction for implementation of Ministry of Health the Republic of Indonesia Decree no 32/1/2014.
18. Fitri E, Andayani TM, &Suparniati E. Cost analysis of diabetes mellitus. JMPF 2015;5(1):61-6.
19. Colagiuri S, Cull CA, Holman RR. Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improve outcomes? Diabetes Care 2002;25:1410-17.
20. Arcavi L, Behar S, Caspi A, Reshef N, Boyko V &Knobler H. High fasting glucose levels as a predictor of worse clinical outcome in patinets with coronary artery disease:results from the bezafibrite infraction prevention (BIP) study. Am Heart J 2004;147(2):239-45.
21. Sherr JL, Boyle CT, Miller KM, Beck RW, Tamborlae WV. No summer vacation from diabetes: glycemic control in pediatric participants in the T1D exchange regsity based on time of year. Diabetes care 2016;39:214-5.
22. Harris MI, Eastman RC, Cowie CC, Flegal KM, &Eberhardt M. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes care 1999;22(3):402-8.
23 Joshua I. Fasting glucose levels and incident diabetes mellitus in older nondiabetic adults randomized to receive 3 different classes of antihypertensive treatment; A report from the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Arch Intern Med 2006; 166(20):2191-2201.
24. Raz I, Wilson PWF, Strojek K, Kowalska I, Bozikov V, Gitt AK, Jermendy G, et.al. Diabetes care 2009;32:381-6.
25. The emerging risk factor collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. www.thelancet.com 2016;375.
26. Jones M, Simpson R, Hylleberg B, Draeger E, Bolinder J. Effect of QD insulin or neutral protamine Hagedorn on blood glucose control in patients with type 1 diabetes mellitus using a basal-bolus regimen. Clin Ther 2004;26(5):724-36.
27. Rudiarta NM. Comparison of treatment effectiveness between JKN and non JKN among type 2 diabetes mellitus outpatients in Udayana Hospital. Skripsi. Bali: University of Udayana.
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