Who Experience Out-of-Pocket Expenditures for Modern Contraceptive Use in Indonesian Universal Health Coverage System?

Abstract

Integration of family planning programs into the universal health coverage system is expected to improve
access toreproductive health services. All people should have access to sufficient and qualified family planning
services they need without financial hardship. This study aimed to examine out-of-pocket expenditures of
contraceptive services and the associated factors among fertile age couples that influence their access to
modern contraceptive services.It was quantitative research with a cross-sectional design. Data obtained from
the Health and Demographic Surveillance System 2016 of Sleman Regency, Indonesia, were analyzed using
multiple logistic regression to determine factors associated with out-of-pocket expenditures for contraceptive
services. This study revealed that more than 70% of people should pay for contraceptive services even
though they had registered as health insurance members. Public non-subsidized and private health insurance
members were more likely to experience OOP expenditures than public-subsidized participants (AOR=3.12;
95%CI=2.25-4.30 and AOR=3.47; 95%CI=1.60-7.52, respectively). Short-term contraception users were
more likely to experience out-of-pocket expenditures thanlong-term users(AOR=6.38; 95%CI=4.79-
8.50).Nearly three-quarters of health insurance participants experience out-of-pocket expenditures for
contraceptive services. Out-of-pocket expenditures of contraceptive services significantly associate with the
type of health insurance owned and the types of contraceptive methods used.