In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health...

Area of Science:

• Cardiology
• Health Economics
• Public Health

Background:

• Cardiovascular diseases pose a significant burden on Indonesia's healthcare system.
• The National Health Insurance (NHI) was implemented in 2014, but its impact on cardiovascular care is understudied.
• Data on NHI's effect on acute coronary syndrome (ACS) patient outcomes in Indonesia is scarce.

Purpose of the Study:

• To describe changes in cardiovascular healthcare following NHI implementation in Indonesia.
• To determine the association between NHI and in-hospital mortality for ACS patients.
• To evaluate the impact of universal health coverage on cardiovascular disease management.

Main Methods:

• Retrospective comparative study of two cohorts of ACS patients at a tertiary cardiac center in Makassar, Indonesia.
• Cohort 1: 364 patients (2013-2014) pre-NHI; Cohort 2: 1142 patients (2018-2020) post-NHI.
• Statistical analysis included chi-square, Mann-Whitney U tests, and multivariable logistic regression.

Main Results:

• NHI user rates increased from 20.1% to 95.6% (p < 0.001).
• ACS patient admissions more than tripled, and invasive treatment rates (thrombolysis, PCI) more than doubled.
• Overall in-hospital mortality decreased by 50.8% (p < 0.001).

Conclusions:

• NHI implementation shows a beneficial effect on cardiovascular healthcare accessibility and treatment.
• Universal health coverage can improve cardiovascular outcomes in low- and middle-income countries.
• The findings support prioritizing UHC for managing cardiovascular disease burdens.