Hubungan Kepemilikan Asuransi Kesehatan dengan Metode Persalinan di Kabupaten Sleman Analisis Data Health and Demographic Surveillance System (HDSS) Sleman Tahun 2015-2021
Main Article Content
Cesarean section (CS) is a critical medical intervention that can save the lives of mothers and babies when performed based on proper clinical indications. However, the rising global and national CS rates raise concerns about unnecessary interventions without medical necessity. The World Health Organization (WHO) recommends an ideal CS rate of 10–15%, yet the global average has reached 18.6%. In Indonesia, the 2023 National Health Survey reported a CS rate of 25.9%, while in Yogyakarta Province it was 38.1%. In Sleman Regency, HDSS data showed an increase from 26.11% (cycle 3) to 34.63% (cycle 5), remaining above WHO’s threshold despite a slight decline afterward. This study applied a retrospective cohort design using Sleman HDSS data from 2015–2021, involving 853 mothers who met inclusion criteria. Data were analyzed with chi-square tests and multivariate logistic regression using STATA to examine the relationship between health insurance ownership and CS, controlling for sociodemographic factors. Results revealed that 68.58% of mothers delivered vaginally, while 31.42% underwent CS. Health insurance ownership was high (73.95%) but showed no significant association with delivery method (AOR = 1.13; 95% CI: 0.79–1.61). Significant factors influencing CS were maternal age >31 years (AOR = 4.96), urban residence (AOR = 1.75), and gestational age >43 weeks (AOR = 5.05), while higher parity reduced CS likelihood (AOR = 0.38). Maternal education and employment were not significant predictors.
Keywords:
Cesarean Delivery, Health Insurance Ownership, Health and Demographic Surveillance System (HDSS), Sleman Regency
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Attali, E., Doleeb, Z., Hiersch, L., Amikam, U., Gamzu, R., Yogev, Y. & Ashwal, E. (2022). The risk of intrapartum cesarean delivery in advanced maternal age. The Journal of Maternal-Fetal & Neonatal Medicine, 35, 8019-8026.
Babitsch, B., Gohl, D. & Von Lengerke, T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine, 9, Doc11.
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BPS Provinsi DIY (2024) Daerah Istimewa Yogyakarta dalam Angka.
BPJS Kesehatan (2020) Kendalikan Kasus Persalinan Caesar, BPJS Kesehatan Perkuat Koordinasi dengan Tim KMKB.
Bruinsma, A., Keulen, J. K., Kortekaas, J. C., Van Dillen, J., Duijnhoven, R. G., Bossuyt, P. M., Van Kaam, A. H., Van Der Post, J. A., Mol, B. W. & De Miranda, E. (2022). Elective induction of labour and expectant management in late-term pregnancy: A prospective cohort study alongside the INDEX randomised controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 16, 100165.
Cheng, Y. (2011) Cesarean Delivery: Factors Affecting Trends. UC Berkeley.
Daniels, A. A., Anaba, E. A. & Nettey, O. E. A. (2025). Correlates of maternal health services utilization among adolescent mothers in Ghana: analysis of Ghana maternal health survey 2017. BMC Pregnancy and Childbirth, 25, 58.
Das, S., Maharjan, R., Bajracharya, R., Shrestha, R., Karki, S., Das, R., Odland, J. Ø. & Odland, M. L. (2023). Pregnancy outcomes in women with gestational hypertension and preeclampsia at Paropakar Maternity and Women’s Hospital, Nepal: A retrospective study. PLoS One, 18, e0286287.
Dinas Kesehatan DIY (2024). Buku Data Kesehatan 2023.
Dinas Kesehatan Kabupaten Sleman (2020). Profil Kesehatan Kabupaten Sleman Tahun 2020.
Dinkes DIY (2023). Buku Data Kesehatan 2022.
Dunne, K., Sherwood, A., Sheth, S., Abdelatif, D. & Mohamed, M. A. (2022) Variations in cesarean deliveries associated with payer type. Proceedings in Obstetrics and Gynecology, 11(1).
Esan, O. T., Adeomi, A. A. & Afolabi, O. T. (2023) Health insurance coverage and access to maternal healthcare services by women of reproductive age in Nigeria: a cross-sectional study. BMJ Public Health, 1(1).
Etty, C. R., Damanik, E., Barus, E. & Salamanang, L. W. (2022) Perilaku Ibu tentang Manajemen Nyeri terhadap Lamanya Persalinan. Prepotif: Jurnal Kesehatan Masyarakat, 6(1): 448-454.
Garg, S., Tripathi, N. & Bebarta, K. K. (2023). Does government health insurance protect households from out of pocket expenditure and distress financing for caesarean and non-caesarean institutional deliveries in India? Findings from the national family health survey (2019-21). BMC research notes, 16, 85.
Gascho, C. L. L., Leandro, D. M. K., Ribeiro, T. & Silva, J. C. (2017). Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics, 39, 060-065.
Ghozali, I. (2016) Aplikasi analisis multivariate dengan program IBM SPSS 23.
Gulshan, J. & Saha, P. (2024). Dhs Working Papers.
Hamzah, H. A., Afladhanti, P. M., Rafika, K., Romadhan, M. D., Deanasa, R. S., Farhan, M. & Chang, P. (2023) The impact of health insurance on maternal health Care in Indonesia: a systematic review.
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