Background: WHO has recommended that all countries apply the concept of Universal Health Coverage (UHC) in their commitment to ensure the health of their people. Although most ASEAN countries have implemented UHC, only 30% of them are considered successful. UHC considers three pillars for its implementation; all groups of people should be covered, at least the basic healthcare services are delivered, and that people could afford to access healthcare when in need. National health insurance had been set up by many countries as the approach to ensure that all citizens could obtain healthcare. However, in Indonesia, after several years of implementation, 33% of the population has yet to register while the 100% target was overdue in 2019.
Objective: To describe the progress towards UHC in Indonesia and determine the strategies used by other countries in ASEAN in achieving UHC.
Methods: Articles on UHC in ASEAN countries between the years 2014-2019 were searched according to PRISMA and reviewed. The articles were compiled using a series keyword in ResearchGate, ScientDirect, ProQuest, SAGE, and EmeraldInsight database. The studies included qualitative studies and written in English.
Results: There are various healthcare financial mechanisms that a country can implement. In 2014, Indonesia had developed a national health insurance known as JKM as its mechanism of financing healthcare towards achieving UHC. However, till date only 54% of her population had registered for JKM. There is no automatic registration via the national identity card and registration for NHIS is only done when there is a need to use the healthcare services.
Conclusion: The review demonstrates that policy implementation still needs to be monitored and evaluated. Recommendations are made for the medical professional association and the government.
Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision method (SICS) and Phacoemulsification method, and it is important to know the cost-effective comparison of those two methods.
Objective: This study aims to conduct Cost-Effectiveness Analysis (CEA) between cataract surgery; Small Incision Cataract Surgery (SICS) and Phacoemulsification, at Undaan Eye Hospital Surabaya.
Materials and Method: A prospective study following up patients from before surgery up to 21 days’ post surgery. A total of 155 cataract patients had undergone surgery; 25 patients and 130 patients had SICS and Phacoemulsification, respectively. Quality-Adjusted Life Years (QALYs) was used as the outcome measure. The assessment of utility using ‘Visual Function 25’ (VF-25) was the quality of life regarding visual function before surgery, 7 days, and 21 days post-surgery.
Result: The average cost of Phacoemulsification technique was Rp 10,821,038 and the average cost of SICS technique was Rp 10,443,544. QALYs at day7 post-surgery of Phacoemulsification and SICS was 9.49 and 8.95, respectively. While QALYs at day21 post- surgery of Phacoemulsification and SICS was 10.37 and 10.15, respectively. ICER values for Phacoemulsification versus SICS at day7 post-surgery was Rp 696,360 (USD 49,74) while at day 21 was Rp 1,723,559 (USD 123,11).
Conclusion: Phacoemulsification and SICS are effective ways to improve the quality of life related to visual function. The incremental cost per QALYs obtained via Phacoemulsification from SICS at D7 and day21 post- surgery were less than Indonesia’s GDP per capita income of USD 3,347, means that Phacoemulsification is more cost effective than SICS technique for cataract surgery.
Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.