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Analysing Utilization Rates of Cesarean Section Births on Jaminan Kesehatan Nasional Scheme in reaching Universal Health Coverage: Evidence from Jakarta
Trisna Budy Widjayanti

Last modified: 2018-08-14



Universal Health Coverage (UHC) is a global policy of universal priority. Indonesia has introduced scheme program known as Jaminan Kesehatan Nasional (JKN) since 2014 held by BPJS. The implementation of the JKN policy enhances people's access to receive cesarean section births services in hospitals. High rates of utilization of cesarean section births lead to increased health financing. However, access to such services is not always equitably distributed.  In this article, we examine the prevalence of cesarean section births and determine the financing factors associated with cesarean section births before and after JKN (UHC).

Material and Methods:

This research uses mixed method research with a cross-sectional study. Quantitative approach analyzing secondary data from administrative data, medical records, and financial data. The qualitative approach using in-depth interviews to Head of Hospital Medical Services and Obstetricians. As a pilot project, this research is in a private hospital. The proportion and percentages were computed. A multiple logistic regression was used to determine the significant predictors associated with cesarean section births.


Before JKN from 2011-2013 there 1088 cases were delivered with cesarean section births. After JKN from 2014-2017 there were 2999 cases were delivered with cesarean section births. Categories more likely to use cesarean section births with BPJS were 2323 cases (OR=0.77; 95%CI) and non BPJS 676 cases (OR=0.22; 95%CI). Prevalence of CS births were 77% (95% CI). Findings underlines member of BPJS using cesarean section births with RR=3,5 (95%CI). The financing factors from 2016 to 2017 we found increasing revenue 12% related to cesarean section births.


Our findings shows that cesarean section births are nearly 3.5 times more after JKN (UHC) as compared to before JKN(UHC). Our recommendation for the government to strengthen existing public health facilities as well as ensure that cesarean sections are performed based upon medical indications. Healthcare personnel, medical colleges, social media have to make an effort to stop the trend of the increasing cesarean rate.


The authors wish to thank University of Indonesia and the Hospital and Prof. Meiwita Budiharsa for his support and guidance in concept building and design studies.


Cesarean section births, JKN, BPJS, Normal delivery, Health Financing