AI Insight
This study evaluated Jamkesus Disabilitas, a specialized health financing scheme for people with disabilities in Yogyakarta Province, Indonesia, through interviews with 30 stakeholders including beneficiaries, disability organizations, government officials, and healthcare providers. The scheme successfully improved access to assistive technology and provided inclusive one-stop services, but faced significant challenges including inconsistent quality of assistive devices, low coverage rates, limited availability, and inadequate data systems for monitoring and planning. The research found that while the program addressed gaps left by national health insurance, it has not fully eliminated healthcare access inequities for people with disabilities because regular healthcare services lack inclusive features.
Why it matters
This evaluation provides crucial insights into designing and implementing disability-focused health financing in low- and middle-income countries, identifying both successful elements to replicate and implementation barriers to address. The findings suggest that specialized schemes alone are insufficient without broader systemic reforms to embed disability-inclusive practices throughout mainstream healthcare delivery systems.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background This study aims to explore the initiation and implementation of Jamkesus Disabilitas, a health financing scheme for people with disabilities in Yogyakarta Province, using the UK Medical Research Council (MRC) Process Evaluation for Complex Intervention. Methods We interviewed 19 people with disabilities with different types of impairment as beneficiaries, 3 people from Organisations for People with Disabilities (OPDs), 4 government officials, and 4 health providers, either in person, online, or by phone. Interviews were conducted by LA, and took place in Yogyakarta Province in July-September 2024. Data were analysed using a thematic analysis approach using NVivo 15 software. Findings Jamkesus Disabilitas has improved access to assistive technology (AT) and demonstrated inclusive care through its one-stop service. It also highlights the importance of consistent leadership in disability-inclusive health systems. However, challenges persist, including uneven AT quality, low coverage, limited availability, and inadequate data for evaluation and planning persisted. Moreover, the absence of inclusive features in the regular service means the scheme has not fully closed the equity gap in healthcare access for people with disabilities. Conclusion Jamkesus Disabilitas has expanded access to AT overlooked by the national health insurance (JKN). However, implementation should prioritise AT quality standards, financial and operational sustainability, and stronger data systems. Broader systemic reforms are also needed to embed disability inclusive practices in regular healthcare service delivery. Keywords Health equity, inclusive health system, social protection, health insurance, health financing