Characteristics of JKN Participants with Schizophrenia in BPJS Kesehatan Sample Data (2024)

Abstract

Schizophrenia is a mental health disorder associated with a substantial disease burden. In Indonesia, 594,383 registered cases were reported between 2022 and September 2024, accounting for 94% of the 631,211 registered cases of people with severe mental disorders. Although the National Health Insurance (Jaminan Kesehatan Nasional/JKN) program has achieved Universal Health Coverage of 98.46%, with an active membership rate of 80%, disparities in mental health service utilization persist and may be influenced by demographic, administrative, and geographic factors. This study aimed to describe the characteristics of JKN participants with schizophrenia and their utilization of primary health care facilities (PHCFs/FKTP) and advanced referral health care facilities (ARHCFs/FKRTL) based on demographic, administrative, and geographic characteristics using the 2024 BPJS Kesehatan mental health contextual sample dataset. A quantitative study with a cross-sectional design was conducted among 17,000 JKN participants with schizophrenia. Descriptive analyses were performed based on membership segment, age, sex, marital status, inpatient class, provincial region, and health service utilization patterns. The results showed that the largest proportion of participants were PBI APBN members (37.34%), aged 15–64 years (91.81%), male (60.14%), unmarried (52.82%), and enrolled in Class III inpatient care (75.95%). Geographically, the largest proportion of participants was distributed in Regional 1 (39.96%), followed by Regional 2 (21.96%) and Regional 5 (18.84%). Regarding health service utilization, the majority of participants utilized both primary and advanced referral health care facilities (65.44%), while 34.56% utilized only one level of health care facility. These findings indicate that most JKN participants with schizophrenia accessed a continuum of care from primary to advanced health care facilities, although variations were observed in participant distribution across membership characteristics and geographic regions. These findings may serve as a basis for strengthening equitable access to mental health services through the optimization of primary health care, strengthening referral systems, developing mental health telemedicine services, and improving community mental health literacy.