How Health Financing Determines The Quality Of Antenatal Care: Evidence From The Universal Health Insurance System In Indonesia

Abstract

Background: Health financing mechanisms play a crucial role in the quality of maternal health services. In Indonesia, the National Health Insurance system (BPJS) and regional financing initiatives (KIBBLA) deliver antenatal care (ANC).

Objective: To compare the quality of ANC services between the KIBBLA and BPJS financing schemes based on inputs, processes, and outcomes.

Methods: A prospective comparative cohort study was conducted at Bangil Regional Hospital, Indonesia. The study recruited 160 pregnant women in their third trimester (80 KIBBLA; 80 BPJS). Datas were collected using a structured questionnaire and a structured observation checklist to assess accessibility, perceived cost, waiting time, adherence to standard operating procedures (SOPs), continuity of care, early detection of complications, appropriateness of referrals, and patient satisfaction according to SERVQUAL. Independent sample t-tests were used to compare group means, p < 0.05.

Results: KIBBLA participants reported significantly better accessibility, shorter waiting times, improved continuity of care, and more appropriate referrals. BPJS showed slightly higher SOP adherence. No significant differences were found in perceived cost, early detection, or overall satisfaction.

Conclusion: ANC quality is influenced by financing-related operational characteristics, showing the need to align financing mechanisms with service delivery processes.