Top

BMC Public Health

Published in:

Open Access 01-12-2024 | COVID-19 | Research

Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis

Authors: Royasia Viki Ramadani, Mikael Svensson, Sven Hassler, Budi Hidayat, Nawi Ng

Published in: BMC Public Health | Issue 1/2024

^Abstract

Background

The COVID-19 pandemic has disrupted healthcare utilization globally, but little is known about the effects among patients with cardiovascular diseases (CVDs) and other multimorbidities. This study analyzed the impacts of COVID-19 on healthcare utilization for patients aged 30 years and older with cardiovascular diseases (CVDs) with or without other chronic disease comorbidities in Indonesia.

Methods

We designed a retrospective cohort study based on the Indonesian National Health Insurance (NHI) sample data from 2016–2020. We defined healthcare utilization as monthly outpatient and inpatient visits related to chronic diseases at the hospital and primary healthcare levels per 10,000 NHI members. We used interrupted time series analysis to evaluate how the healthcare utilization patterns had changed due to the COVID-19 pandemic.

Results

Overall, hospital outpatient visits decreased by 39% when the pandemic occurred (95% Confidence Interval (CI): 0.48,0.76), inpatient visits by 28% (95% CI: 0.62,0.83), and primary healthcare visits by 34% (95% CI:0.55, 0.81). For patients with CVDs and multimorbidity, hospital outpatient and inpatient visit rates were reduced by 36% and 38%, respectively and primary healthcare visits by 32%. Some insignificant differences in the reduction of out-and inpatient visits were observed across diagnosis groups and regions.

Conclusion

Healthcare utilization among patients with chronic diseases decreased significantly during COVID-19 and consistently across different chronic diseases and regions. To cope with the unmet needs of healthcare utilization in the context of the pandemic, the healthcare system needs to be strengthened to cater to the needs of the population-at-risk, especially for patients with CVDs and multimorbidity.

Available only for authorised users

World Health Organization. The impact of the COVID-19 pandemic on noncommunicable disease resources and services: results of a rapid assessment. 2020. Accessed.

Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States: study examines trends in US hospital admissions during the COVID-19 pandemic. Health Aff. 2020;39:2010–7.CrossRef

Rennert-May E, Leal J, Thanh NX, Lang E, Dowling S, Manns B, et al. The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study. PLoS One. 2021;16: e0252441.CrossRefPubMedPubMedCentral

Xiao H, Dai X, Wagenaar BH, Liu F, Augusto O, Guo Y, et al. The impact of the COVID-19 pandemic on health services utilization in China: Time-series analyses for 2016–2020. The Lancet Regional Health-Western Pacific. 2021;9: 100122.CrossRefPubMedPubMedCentral

Roy CM, Bollman EB, Carson LM, Northrop AJ, Jackson EF, Moresky RT. Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review. Eur J Public Health. 2021;31:634–40.CrossRefPubMed

Desai SM, Guyette FX, Martin-Gill C, Jadhav AP. Collateral damage - Impact of a pandemic on stroke emergency services. J Stroke Cerebrovasc Dis. 2020;29: 104988.CrossRefPubMedPubMedCentral

Institute for Health Metrics and Evaluation .Global Burden of Diseases: Indonesia. 2019. Available: https://www.healthdata.org/data-visualization/gbd-compare. Accessed.

Hussain MA, Huxley RR, Al MA. Multimorbidity prevalence and pattern in indonesian adults: an exploratory study using national survey data. BMJ Open. 2015;5: e009810.CrossRefPubMedPubMedCentral

Madyaningrum E, Chuang Y-C, Chuang K-Y. Factors associated with the use of outpatient services among the elderly in Indonesia. BMC Health Serv Res. 2018;18:707.CrossRefPubMedPubMedCentral

10.

Marthias T, Anindya K, Ng N, McPake B, Atun R, Arfyanto H, et al. Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study. BMJ Open. 2021;11: e041870.CrossRefPubMedPubMedCentral

11.

Anindya K, Ng N, Atun R, Marthias T, Zhao Y, McPake B, et al. Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis. BMC Health Serv Res. 2021;21:1–12.CrossRef

12.

Sambodo NP, Van Doorslaer E, Pradhan M, Sparrow R. Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia. Health Policy Plan. 2021;36:1129–39.CrossRefPubMedPubMedCentral

13.

Mulyanto J, Kunst AE, Kringos DS. The contribution of service density and proximity to geographical inequalities in health care utilisation in Indonesia: A nation-wide multilevel analysis. Journal of Global Health. 2020;10.

14.

National Health Insurance Agency. Number of JKN Member (In Indonesian: BPJS Kesehatan. Peserta Program JKN). 2022. Available: https://faskes.bpjs-kesehatan.go.id/aplicares/#/app/peta. Accessed.

15.

Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Achadi EL, Taher A, et al. Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet. 2018.

16.

Erlangga D, Ali S. Bloor KJIjoph. The impact of public health insurance on healthcare utilisation in Indonesia: evidence from panel data. 2019;64:603–13.

17.

Johar M, Soewondo P, Pujisubekti R, Satrio HK, Adji A. Inequality in access to health care, health insurance and the role of supply factors. Soc Sci Med. 2018;213:134–45.CrossRefPubMed

18.

DJSN and BPJS Kesehatan. JKN Statistic 2015–2019 (In Indonesian: DJSN dan BPJS Kesehatan. Statistik JKN 2015–2019). Jakarta2021 [cited 2021 13 July 2021].

19.

BPJS Kesehatan. Documentation of Baseline Projection of Social Security Fund for the Period 2022–2026 (In Indonesian: BPJS Kesehatan. Dokumentasi Proyeksi Baseline Dana Jaminan Sosial Periode 2022–2026). 2022.

20.

Government Regulation. Government Regulation on Large-Scale Social Restrictions in the Context of Accelerating the Handling of Corona Virus Disease 2019 (COVID-19) 2020 (In Indonesian: Peraturan Pemerintah.Peraturan Pemerintah (PP) tentang Pembatasan Sosial Berskala Besar dalam Rangka Percepatan Penanganan Corona Virus Disease 2019 (COVID-19)). 2020. Available: https://peraturan.bpk.go.id/Home/Details/135059/pp-no-21-tahun-2020. Accessed.

21.

Circular Letter Number: HK.02.02/11/509/2020 Regarding Family Health Services in the Era of the COVID-19 Pandemic (In Indonesian: Kementerian Kesehatan. Surat Edaran Nomor: HK.02.02/11/509/2020 Tentang Pelayanan Kesehatan Keluarga di Era Pandemi COVID-19), (2020).

22.

TNP2K. Assessment of The Potential Effects of Policy Responses and Public Financial Management (PFM) Adjustment for the Continuation of Four Essential Public Health Services at the Primary Health Care Centre (PHC) Level During the COVID-19 Pandemic in Indonesia. Jakarta, Indonesia: TNP2K: 2021.

23.

Ariawan I, Sartono B, Jaya C, Mawardi J, Sodiq J, Baros W, et al. BPJS Health Sample Data for 2015–2021 (In Indonesian: Data Sampel BPJS Kesehatan Tahun 2015–2021). Jakarta: BPJS Kesehatan. 2022.

24.

Agency for Healthcare Research and Quality R, MD,. Tools Archive for the Chronic Condition Indicators for ICD-10-CM. Healthcare Cost and Utilization Project (HCUP). 2020. Available: https://www.hcup-us.ahrq.gov/toolssoftware/chronic_icd10/chronic_icd10.jsp#overview. Accessed.

25.

Institute for Health Metrics and Evaluation. Global Burden of Disease Study 2017 (GBD 2017) Causes of Death and Nonfatal Causes Mapped to ICD Codes. 2017. Available: http://ghdx.healthdata.org/record/ihme-data/gbd-2017-cause-icd-code-mappings. Accessed.

26.

Koller D, Schön G, Schäfer I, Glaeske G, van den Bussche H, Hansen H. Multimorbidity and Long-term Care Dependency—a five-year follow-up. BMC Geriatr. 2014;14:70.CrossRefPubMedPubMedCentral

27.

Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46:348–55.PubMed

28.

Bernal JL, Cummins S, Gasparrini A. Corrigendum to: Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2021;50:1045.CrossRef

29.

Save The Children and Center for Health Economics and Policy Studies. Health Service Access for Children in Bandung and West Sumba Districts. 2020.

30.

Coordinating Ministry for Economic Affairs of the Republic of Indonesia and the Committee for COVID-19 Handling and National Economic Recovery. COVID-19 vaccination in Indonesia (In Indonesian: Kementerian Koordinator Bidang Perekonomian Republik Indonesia dan Komite Penanganan COVID-19 dan Pemulihan Ekonomi Nasional. Vaksinasi COVID-19 di Indonesia). 2022.

31.

Stamenova V, Chu C, Pang A, Fang J, Shakeri A, Cram P, et al. Virtual care use during the COVID-19 pandemic and its impact on healthcare utilization in patients with chronic disease: A population-based repeated cross-sectional study. PLoS One. 2022;17: e0267218.CrossRefPubMedPubMedCentral

32.

Kang E, Yun J, Hwang SH, Lee H, Lee JY. The impact of the COVID-19 pandemic in the healthcare utilization in Korea: Analysis of a nationwide survey. J Infect Public Health. 2022;15:915–21.CrossRefPubMedPubMedCentral

33.

Selke Krulichová I, Selke GW, Bennie M, Hajiebrahimi M, Nyberg F, Fürst J, et al. Comparison of drug prescribing before and during the COVID-19 pandemic: A cross-national European study. Pharmacoepidemiol Drug Saf. 2022;31:1046–55.CrossRefPubMedPubMedCentral

34.

Diamantidis CJ, Cook DJ, Dunning S, Redelosa CK, Bartolome MFD, Romero RAA, et al. Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery. J Gen Intern Med. 2022;37:4241–7.CrossRefPubMedPubMedCentral

35.

Central Buerau Statistics of Indonesia Population Projection by Province and Sex (Thousand), 2018–2020 2020 (In Indonesian: BPS. Jumlah Penduduk Hasil Proyeksi Menurut Provinsi dan Jenis Kelamin (Ribu Jiwa), 2018–2020). 2020. Available: https://www.bps.go.id/indicator/12/1886/1/jumlah-penduduk-hasil-proyeksi-menurut-provinsi-dan-jenis-kelamin.html. Accessed.

36.

Ministry of Finance. Annual Data on the Realization of Health Expenditure at the Regency / City level throughout Indonesia for a period of 10 years, namely 2010 to 2019 (In Indonesian: Kementerian Keuangan. Data Tahunan Realisasi Belanja Kesehatan tingkat Kabupaten/Kota di seluruh Indonesia pada periode waktu 10 tahun, yaitu Tahun 2010 sampai dengan Tahun 2019). 2020. Available: https://djpk.kemenkeu.go.id/?p=20826. Accessed.

37.

Central Buerau Statistics of Indonesia. Number of General Hospitals, Special Hospitals, Puskesmas, Primary Clinics, and Posyandu by Province, 2021 (In Indonesian: BPS. Jumlah Rumah Sakit Umum, Rumah Sakit Khusus, Puskesmas, Klinik Pratama, dan Posyandu Menurut Provinsi, 2021). 2021. Available: https://www.bps.go.id/indikator/indikator/view_data_pub/0000/api_pub/biszcFRCUnVKUXNnTDZvWnA3ZWtyUT09/da_04/1. Accessed.

38.

Maharani A, Tampubolon G. Unmet needs for cardiovascular care in Indonesia. PLoS ONE. 2014;9: e105831.CrossRefPubMedPubMedCentral

39.

Dunbar SB, Khavjou OA, Bakas T, Hunt G, Kirch RA, Leib AR, et al. Projected costs of informal caregiving for cardiovascular disease: 2015 to 2035: a policy statement from the American Heart Association. Circulation. 2018;137:e558–77.CrossRefPubMed

40.

Decree of the Minister of Health of the Republic of Indonesia No HK.01.07/Menkes/446/2020 concerning Technical Guidelines for Reimbursement Claims for Patient Services for Certain Emerging Infectious Diseases for Hospitals Organizing Corona Virus Disease 2019 (COVID-19) Services (In Indonesia: Keputusan Menteri Kesehatan Republik Indonesia No HK.01.07/Menkes/446/2020 tentang Petunjuk Teknis Klaim Penggantian Biaya Pelayanan Pasien Penyakit Infeksi Emerging Tertentu bagi Rumah Sakit yang Menyelenggarakan Pelayanan Corona Virus Disease 2019 (COVID-19), (2020).

41.

Ugarte MP, Achilleos S, Quattrocchi A, Gabel J, Kolokotroni O, Constantinou C, et al. Premature mortality attributable to COVID-19: potential years of life lost in 17 countries around the world, January–August 2020. BMC Public Health. 2022;22:54.CrossRefPubMedPubMedCentral

42.

Doubova SV, Arsenault C, Contreras-Sánchez SE, Borrayo-Sánchez G, Leslie HH. The road to recovery: an interrupted time series analysis of policy intervention to restore essential health services in Mexico during the COVID-19 pandemic. Journal of global health. 2022;12.

Title: Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis
Authors: Royasia Viki Ramadani
Mikael Svensson
Sven Hassler
Budi Hidayat
Nawi Ng
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: COVID-19
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-023-17568-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis

^Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

The mediating role of children’s intergenerational support in association between grandparenting and cognitive function among middle-aged and older Chinese: findings from the CHARLS cohort study

Association between vitamin B2 intake and prostate-specific antigen in American men: 2003–2010 National Health and Nutrition Examination Survey

Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern

Gender differences in changes in alcohol consumption achieved by free provision of non-alcoholic beverages: a secondary analysis of a randomized controlled trial

Secondary analyses of sex differences in attention improvements across three clinical trials of a digital therapeutic in children, adolescents, and adults with ADHD

^Abstract