Geographic variation in potentially preventable hospitalisations in Indonesia: a multilevel analysis using National...

Area of Science:

• Public Health
• Healthcare Quality Measurement
• Health Services Research

Background:

• Potentially preventable hospitalizations (PPH) are a key indicator for primary healthcare (PHC) quality.
• Indonesia lacks comprehensive data on PPH rates and their determinants.
• Understanding PPH variation is crucial for assessing and improving healthcare delivery.

Purpose of the Study:

• To describe PPH rates across Indonesian districts/cities.
• To quantify geographic and sociodemographic variations in PPH.
• To assess the association between PPH and individual characteristics.

Main Methods:

• Cross-sectional study using 2023 National Health Insurance (JKN) sample data (2.32 million individuals).
• Analysis of overall PPH and by type: vaccine-preventable, acute, and chronic.
• Multilevel negative binomial regression to estimate variation (MRR) and associations (IRR).

Main Results:

• Overall PPH rate was 180.9 per 10,000 JKN enrollees, with significant variation across districts/cities (MRR 1.62).
• PPH rates were higher in older adults (chronic) and younger children (acute, vaccine-preventable), and among married/divorced and non-subsidized enrollees.
• Geographic disparities were observed, with higher rates in Java-Bali, Sulawesi, Sumatera, and Kalimantan.

Conclusions:

• PPH in Indonesia exhibits substantial variation by geographic location and sociodemographic factors.
• PPH can inform PHC quality assessment, but requires careful interpretation due to potential confounding by healthcare access.
• Context-specific analysis is essential for accurate evaluation of PHC performance using PPH indicators.