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. 2018 Aug 18;392(10147):581-591.
doi: 10.1016/S0140-6736(18)30595-6. Epub 2018 Jun 28.

On the road to universal health care in Indonesia, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Nafsiah Mboi  1 , Indra Murty Surbakti  2 , Indang Trihandini  3 , Iqbal Elyazar  4 , Karen Houston Smith  5 , Pungkas Bahjuri Ali  6 , Soewarta Kosen  5 , Kristin Flemons  7 , Sarah E Ray  8 , Jackie Cao  8 , Scott D Glenn  8 , Molly K Miller-Petrie  8 , Meghan D Mooney  8 , Jeffrey L Ried  8 , Dina Nur Anggraini Ningrum  9 , Fachmi Idris  10 , Kemal N Siregar  3 , Pandu Harimurti  11 , Robert S Bernstein  12 , Tikki Pangestu  13 , Yuwono Sidharta  14 , Mohsen Naghavi  8 , Christopher J L Murray  8 , Simon I Hay  15
Affiliations

On the road to universal health care in Indonesia, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Nafsiah Mboi et al. Lancet. .

Abstract

Background: As Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care.

Methods: We used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results.

Findings: In Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3-8·8) to 71·7 years (71·0-72·3): the increase was 7·4 years (6·4-8·6) for males and 8·7 years (7·8-9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6-61·6), from 43·8 million (95% UI 41·4-46·5) to 18·1 million (16·8-19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8-15·4) of DALYs in 2016.

Interpretation: Over the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity.

Funding: The Bill & Melinda Gates Foundation.

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Figures

Figure 1
Figure 1
Attribution of changes in life expectancy at birth to changes in major groups of causes of death for Indonesia and comparator countries, 1990–2016, by sex Changes are shown for Indonesia and comparator countries for both sexes, males, and females. Locations are ordered by life expectancy at birth in 2016, from highest to lowest. Purple lines show life expectancy at birth in 1990, and black lines show life expectancy at birth in 2016; for all countries except the Philippines, these lie at the beginning and end of each bar, respectively. *In the Philippines, the increase in life expectancy attributable to changes in injuries and communicable, maternal, neonatal, and nutritional causes was countered by a decrease in life expectancy attributable to non-communicable diseases, leading to a smaller net increase in life expectancy than the overall change.
Figure 2
Figure 2
Trends in DALYs (total number, crude rates, and age-standardised rates) from 1990 to 2016 by GBD Level 1 cause groups: communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; and injuries The difference in trends between total DALYs and crude DALY rates is caused by population growth, and the difference between crude and age-standardised rates is caused by changes in the percentage distribution of the population by age. Shaded areas show 95% uncertainty intervals. DALYs=disability-adjusted life-years.
Figure 3
Figure 3
Leading 30 Level-3 causes of DALYs in Indonesia for 1990, 2006, and 2016, with percentage change in number of DALYs and all-age and age-standardised DALY rates Causes of DALYs for both sexes combined are ordered by total DALYs and are connected by arrows between time periods. For the time periods 1990–2006 and 2006–16, three measures of change are shown: median percent change in the number of DALYs, median percent change in the all-age DALY rate, and median percent change in the age-standardised DALY rate. Median values across the 1000 draws from the uncertainty distribution are shown. Numbers in bold are statistically significant (α=0·05). DALYs=disability-adjusted life-years. COPD=chronic obstructive pulmonary disease. STDs=sexually transmitted diseases. Cirrhosis/other liver disease=cirrhosis and other chronic liver diseases. Intestinal infectious=other intestinal infectious diseases.
Figure 4
Figure 4
Ranking of age-standardised DALYs attributable to Level 2 risk factors in Indonesia and comparator countries in 2016 DALYs=disability-adjusted life-years.
Figure 5
Figure 5
Ratio of observed to expected age-standardised rates of YLLs among ten leading causes of YLLs in Indonesia and comparator countries in 1990 and 2016 YLLs=years of life lost. COPD=chronic obstructive pulmonary disease.
Figure 6
Figure 6
DALYs attributable to Level 2 risk factors in Indonesia in 2016, by sex DALYs=disability-adjusted life-years.
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References

    1. Mahendradhata Y, Trisnantoro L, Listyadewi S. Asia Pacific Observatory on Health Systems and Policies; New Delhi: 2017. Indonesian health system review.
    1. Mboi N. Indonesia: on the way to universal health care. Health Syst Reform. 2015;1:91–97. - PubMed
    1. Indonesian Ministry of National Development Planning . Kementerian PPN/Bappenas; Jakarta: 2014. Indonesian health sector review.
    1. Healthcare and Social Security Agency Peserta Program JKN per 14 November 2017 (JKN Program Membership). Healthcare and Social Security Agency/BPJS Indonesia. 2017. https://bpjs-kesehatan.go.id/bpjs/index.php/jumlahPeserta
    1. Ministry of Health, Secretariat General. Ministry of Health's strategic plan, 2015–2019. Jakarta: Indonesia, 2015.

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