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Cancer Survival Under Universal Health Coverage: Evidence from Indonesia's National Health Insurance System

Public Health of Indonesia · Vol. 12 No. 2 (2026) · hlm. 30–42

DOI
10.36685/phi.v12i2.2041
ISSN
2477-1570, 2528-1542
Terbit
2026-06-18
Penerbit
YCAB Publisher
Bahasa
eng
Lisensi
creativecommons.org/licenses/by-nc/4.0

Abstrak

Background: Universal health coverage (UHC) aims to ensure equitable access to quality healthcare services. Indonesia's National Health Insurance (BPJS Kesehatan), covering 248.8 million people, provides unprecedented opportunities to examine cancer survival patterns under UHC implementation. However, survival outcomes and factors influencing mortality among cancer patients within this system remain underexplored. Objective: To analyze survival outcomes and identify factors associated with mortality among cancer patients covered by Indonesia's National Health Insurance from 2017-2023. Methods: A retrospective longitudinal cohort study was conducted using BPJS Kesehatan administrative data. From a database of 2.501.251 JKN participants, 2.444 patients with cancer diagnoses (ICD-10: C00-C97) were identified. After applying eligibility criteria, 330 patients diagnosed since 2017 were eligible, with 316 patients included in final analysis after excluding incomplete data. Cox proportional hazards regression was employed to identify factors associated with survival time. Variables analyzed included comorbidity status, insurance scheme type, regional healthcare access, regional setting, age groups, and gender. Results: The analysis included 316 cancer patients with overall mortality rate of 52.8%. Female patients comprised 64.9% of the cohort, with 47.8% in the 40-59 years age group. Urban (Kota) patients represented 77.5%. Patients with documented mild complications showed significantly better survival (HR=0.360, 95% CI: 0.331-0.392, p<0.001) compared to those without complications. Severe complications also demonstrated improved survival (HR=0.482, 95% CI: 0.440-0.527, p<0.001). Insurance scheme type emerged as a critical factor, with PBI APBN patients showing 2.3-fold increased death hazard (HR=2.306, 95% CI: 2.086-2.548, p<0.001), while PBPU patients had 55% reduced hazard (HR=0.445, 95% CI: 0.412-0.479, p<0.001). Substantial regional variations were observed, with Regional 3 showing 3-fold increased death hazard (HR=2.957, 95% CI: 2.682-3.260, p<0.001). Age group 40-59 years demonstrated optimal survival (HR=0.553, 95% CI: 0.514-0.596, p<0.001). Female patients showed 26% increased death hazard (HR=1.259, 95% CI: 1.185-1.338, p<0.001), and rural (Kabupaten) patients had 54% increased survival (HR=1.535, 95% CI: 1.426-1.653, p<0.001) compared to urban patients. Conclusion: Cancer survival outcomes under Indonesia's universal health coverage system are significantly influenced by insurance scheme type, complication documentation status, regional healthcare access, urban-rural disparities, age, and gender, revealing substantial inequities within the UHC framework that require targeted policy interventions to achieve equitable cancer care.

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  • University of Indonesia
  • Universitas Halu Oleo
  • Universitas Pembangunan Nasional Veteran Jakarta
  • Universitas Muhammadiyah Kudus
  • Sriwijaya University
  • Afiliasi tidak diketahui
  • Organisasi berbeda
  • Organisasi sama
  • Afiliasi tidak diketahui
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Tampilkan sebagai tabel
Rekan penulisOrganisasiArtikel bersama
Elly NurachmahUniversity of Indonesia10
Syawal Kamiluddin SaptaputraUniversitas Halu Oleo4
Hariati LestariUniversitas Halu Oleo4
Devi Savitri EffendyUniversitas Halu Oleo4
Ramadhan TosepuUniversitas Halu Oleo4
Pitrah AsfianUniversitas Halu Oleo4
Budi Anna KeliatUniversity of Indonesia3
Yati AfiyantiUniversity of Indonesia3
Hartati BaharUniversitas Halu Oleo3
La Ode Ali Imran AhmadUniversitas Halu Oleo3
Ratna SitorusUniversity of Indonesia3
Sukarmin SukarminUniversitas Muhammadiyah Kudus2
Nani NurhaeniUniversity of Indonesia2
Junaiti SaharUniversity of Indonesia2
Tuti NurainiUniversity of Indonesia2
Rastika Dwiyanti LiaranUniversitas Halu Oleo1
Servia Juliyanti R.SUniversitas Halu Oleo1
Hilda HarunUniversitas Halu Oleo1
Nova Alfriana AjubraUniversitas Halu Oleo1
Agnes Mersatika HartoyoUniversitas Halu Oleo1
Muhammad Muladi TamrinUniversitas Halu Oleo1
Cinthia AristhaAfiliasi tidak diketahui1
Chindy FajriahAfiliasi tidak diketahui1
Dandi SanjayaAfiliasi tidak diketahui1
Deri SilambiAfiliasi tidak diketahui1
Annisa UlfahAfiliasi tidak diketahui1
Astri NurdianaUniversity of Indonesia1
Solikhah YuliatiningtyasUniversity of Indonesia1
Renny NurhasanaUniversity of Indonesia1
Aji MuhawarmanUniversity of Indonesia1
Miananiarti MisnaniartiAfiliasi tidak diketahui1
Ratih OktarinaUniversity of Indonesia1
Misnaniarti MisnaniartiSriwijaya University1
Ni Nyoman Dwi SutrisnawatiAfiliasi tidak diketahui1
Ovi NorfianaAfiliasi tidak diketahui1

Afiliasi berasal dari OpenAlex; metadata OAI-PMH jurnal tidak memuatnya. Penulis tanpa ID OpenAlex dicocokkan berdasarkan nama, sehingga dua orang bisa tergabung atau satu orang bisa terpisah.

Sumber metadata: OAI-PMH (metadata jurnal) http://stikbar.org/ycabpublisher/index.php/PHI/oai, pertama di-harvest 10 Nov 2026, terakhir terlihat 10 Nov 2026.
Metadata asli (oai_dc) 
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	<dc:title xml:lang="en-US">Cancer Survival Under Universal Health Coverage: Evidence from Indonesia's National Health Insurance System</dc:title>
	<dc:creator>Sakka, Ambo</dc:creator>
	<dc:creator>Darmawan, Ede Surya</dc:creator>
	<dc:creator>Ayuningtyas, Dumilah</dc:creator>
	<dc:creator>Gayatri, Dewi</dc:creator>
	<dc:creator>Hasibuan, Syarif Rahman</dc:creator>
	<dc:subject xml:lang="en-US">cancer survival</dc:subject>
	<dc:subject xml:lang="en-US">universal health coverage</dc:subject>
	<dc:subject xml:lang="en-US">national health insurance</dc:subject>
	<dc:subject xml:lang="en-US">BPJS Kesehatan</dc:subject>
	<dc:subject xml:lang="en-US">health equity</dc:subject>
	<dc:subject xml:lang="en-US">Indonesia</dc:subject>
	<dc:description xml:lang="en-US">Background: Universal health coverage (UHC) aims to ensure equitable access to quality healthcare services. Indonesia's National Health Insurance (BPJS Kesehatan), covering 248.8 million people, provides unprecedented opportunities to examine cancer survival patterns under UHC implementation. However, survival outcomes and factors influencing mortality among cancer patients within this system remain underexplored.
Objective: To analyze survival outcomes and identify factors associated with mortality among cancer patients covered by Indonesia's National Health Insurance from 2017-2023.
Methods: A retrospective longitudinal cohort study was conducted using BPJS Kesehatan administrative data. From a database of 2.501.251 JKN participants, 2.444 patients with cancer diagnoses (ICD-10: C00-C97) were identified. After applying eligibility criteria, 330 patients diagnosed since 2017 were eligible, with 316 patients included in final analysis after excluding incomplete data. Cox proportional hazards regression was employed to identify factors associated with survival time. Variables analyzed included comorbidity status, insurance scheme type, regional healthcare access, regional setting, age groups, and gender.
Results: The analysis included 316 cancer patients with overall mortality rate of 52.8%. Female patients comprised 64.9% of the cohort, with 47.8% in the 40-59 years age group. Urban (Kota) patients represented 77.5%. Patients with documented mild complications showed significantly better survival (HR=0.360, 95% CI: 0.331-0.392, p&amp;lt;0.001) compared to those without complications. Severe complications also demonstrated improved survival (HR=0.482, 95% CI: 0.440-0.527, p&amp;lt;0.001). Insurance scheme type emerged as a critical factor, with PBI APBN patients showing 2.3-fold increased death hazard (HR=2.306, 95% CI: 2.086-2.548, p&amp;lt;0.001), while PBPU patients had 55% reduced hazard (HR=0.445, 95% CI: 0.412-0.479, p&amp;lt;0.001). Substantial regional variations were observed, with Regional 3 showing 3-fold increased death hazard (HR=2.957, 95% CI: 2.682-3.260, p&amp;lt;0.001). Age group 40-59 years demonstrated optimal survival (HR=0.553, 95% CI: 0.514-0.596, p&amp;lt;0.001). Female patients showed 26% increased death hazard (HR=1.259, 95% CI: 1.185-1.338, p&amp;lt;0.001), and rural (Kabupaten) patients had 54% increased survival (HR=1.535, 95% CI: 1.426-1.653, p&amp;lt;0.001) compared to urban patients.
Conclusion: Cancer survival outcomes under Indonesia's universal health coverage system are significantly influenced by insurance scheme type, complication documentation status, regional healthcare access, urban-rural disparities, age, and gender, revealing substantial inequities within the UHC framework that require targeted policy interventions to achieve equitable cancer care.</dc:description>
	<dc:publisher xml:lang="en-US">YCAB Publisher</dc:publisher>
	<dc:date>2026-06-18</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:type xml:lang="en-US">Peer-reviewed Article</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://stikbar.org/ycabpublisher/index.php/PHI/article/view/2041</dc:identifier>
	<dc:identifier>10.36685/phi.v12i2.2041</dc:identifier>
	<dc:source xml:lang="en-US">Public Health of Indonesia; Vol. 12 No. 2 (2026): April - June; 30 - 42</dc:source>
	<dc:source>2477-1570</dc:source>
	<dc:source>2528-1542</dc:source>
	<dc:source>10.36685/phi.v12i2</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>https://stikbar.org/ycabpublisher/index.php/PHI/article/view/2041/774</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2026 Ambo Sakka</dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by-nc/4.0</dc:rights>
</oai_dc:dc>