Factors associated with antenatal care utilization among national health insurance participants in North Maluku: An analysis of BPJS Kesehatan sample data
https://doi.org/10.52235/lp.v7i3.915
Keywords:
Antenatal Care, BPJS Kesehatan, Health Service Utilization, Maternal HealthAbstract
Background: Maternal mortality remains a public health concern in North Maluku. Antenatal care (ANC) is essential for early risk detection, but the utilization recorded in health insurance claims may vary according to participant and healthcare-system characteristics.
Objective: To analyze factors associated with recorded ANC utilization among National Health Insurance (JKN) participants in North Maluku using BPJS Kesehatan Sample Data.
Methods: This cross-sectional secondary-data study used the 2025 BPJS Kesehatan Sample Data, with healthcare claims from 2021–2024. Total sampling included 179 eligible JKN participant–delivery episodes. Recorded ANC utilization was defined as the number of unique primary healthcare facility service dates coded Z32–Z36 within 280 days before an indexed delivery coded O80–O84 and was categorized as <4 or ≥4 visits. Participant and facility characteristics were analyzed using Chi-square or Fisher’s exact tests and binary logistic regression.
Results: Of 179 observations, 113 (63.13%) had <4 recorded ANC visits and 66 (36.87%) had ≥4 visits. Residential area (p=0.049), type of primary healthcare facility (p<0.001), and facility region (p=0.035) were associated with ANC utilization in bivariate analysis. In the adjusted model, only the facility-type code remained statistically significant. For each one-level increase in the dataset code (community health center=1, primary clinic=2, general practitioner=3, network facility=4), the adjusted odds of ≥4 recorded visits were 3.55 times higher (adjusted OR=3.550; 95% CI: 1.826–6.901; p<0.001). This estimate should be interpreted cautiously because the categories are not clinically ordinal and several cells were small.
Conclusion: Among JKN participants included in the 2025 BPJS Kesehatan Sample Data who met the study algorithm, recorded ANC utilization was associated with facility characteristics. The findings describe claim-recorded utilization and should not be generalized to all pregnant women in North Maluku or interpreted as evidence of causal effects or clinical ANC completeness.
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