Abstract
OBJECTIVES: This study examined factors associated with the use of Indonesia's National Health Insurance (NHI) among its beneficiaries in Maluku province. DESIGN: Cross-sectional study. SETTING: The individual-level data were derived from the 2021 Social Health Insurance Sample Data. National health reports of Indonesia were used to provide the district-level variables. We performed multivariable logistic regression analyses to identify factors associated with NHI use among its beneficiaries in Maluku province. PARTICIPANT: Data were collected from 31 517 NHI beneficiaries registered in Maluku. PRIMARY OUTCOME: The primary outcome was the use of NHI insurance when accessing healthcare services (yes/no). RESULTS: Only 14.79% of NHI beneficiaries in Maluku had ever used their insurance for healthcare services. Individual factors associated with higher NHI use included being under 60 years, females (adjusted OR (aOR)=1.29, p<0.001), married (aOR=1.83, p<0.001) and having non-subsidised insurance (aOR=1.12, p<0.001). At the district level, higher usage was associated with increased rates of joint diseases (aOR=1.19, p<0.001), hypertension (aOR=1.81, p<0.001), diarrhoea (aOR=1.24, p<0.001) and a higher doctor-to-population ratio (aOR=1.01, p<0.001). A reduced likelihood of NHI use was found in beneficiaries living in the districts with high rates of acute respiratory infections (aOR=0.86, p<0.001) and with a high fiscal capacity (aOR=0.14, p<0.001). CONCLUSION: Strengthening primary healthcare accessibility, improving the distribution of healthcare workers and addressing socioeconomic and geographical disparities are essential to ensure that the NHI scheme achieves equitable use across all regions in Maluku and other areas with similar settings.