Background This study investigates disparities in the utilization of primary health care (PHC) between urban and rural populations in Indonesia, focusing on socioeconomic and demographic determinants. Understanding these patterns is essential for promoting equity under the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program.
Methods Data were obtained from the 2023 National Socioeconomic Survey, which included 334,887 individuals. Binary logistic regression was used to examine the association between individual characteristics and PHC utilization.
Results Overall utilization rates were similar across urban and rural areas, but significant disparities were observed. Women were more likely to use PHC than men (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.10–1.13). The association between higher education and PHC utilization was negative (OR, 0.78; 95% CI, 0.75–0.81), while access to information technology slightly reduced utilization (OR, 0.98; 95% CI, 0.96–0.99). Wealth effects diverged sharply: affluent urban residents were less likely to use PHC (OR, 0.84; 95% CI, 0.81–0.87), whereas wealthier rural residents were more likely to utilize PHC (OR, 1.09; 95% CI, 1.05–1.13). Dual insurance ownership had a strong positive effect in rural areas (OR, 1.56; 95% CI, 1.25–1.94).
Conclusion These findings highlight structural inequalities in PHC utilization. Policy efforts must prioritize enhancing the quality and attractiveness of PHC in urban areas, improving financial protection and infrastructure in rural areas, and addressing the digital divide. Such targeted measures are essential for achieving equitable and inclusive health coverage under JKN.
Background Indonesia faces significant maternal and child health challenges, including a high maternal mortality ratio. The country’s vast geography results in disparities in healthcare facility availability. This study aimed to identify factors influencing maternal delivery choices in health facilities across Indonesia’s rural and urban areas.
Methods This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. The study population included women aged 15–49 who had given birth within 5 years preceding the survey. A total of 14,162 women were included, with 6,339 from urban and 5,009 from rural areas. Logistic regression was performed to identify factors associated with maternal delivery locations.
Results The findings showed that 91.37% of urban and 69.33% of rural mothers delivered in healthcare facilities. All analyzed variables were significantly correlated with maternal delivery in health facilities across both areas. In rural areas, the sex of the household head (adjusted odds ratio [AOR], 1.32; 95% confidence interval [CI], 1.02–1.71; P=0.031) and the absence of barriers to healthcare access (AOR, 1.31; 95% CI, 1.07–1.60; P=0.008) were significant factors. Conversely, in urban areas, only maternal age was significantly associated with delivering in health facilities.
Conclusion Determinants of maternal delivery choices vary between rural and urban settings. In rural areas, healthcare access and household head sex are key factors, while maternal age is significant in urban areas. The government should prioritize equitable healthcare facility distribution, particularly in rural areas, and promote family involvement, especially among husbands, during antenatal care to encourage facility-based deliveries.
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Family medicine for all stages of life: turning knowledge into actionable care Joung Sik Son Korean Journal of Family Medicine.2026; 47(2): 95. CrossRef
Background Malnutrition is common among children under 5 years of age in Indonesia, with the rates varying between urban and rural areas. The minimum acceptable diet (MAD) assesses nutrient quality and quantity. This study aimed to identify the potential variables for MAD in 6–23-month-old children in both urban and rural Indonesia.
Methods We used the data from the 2017 Indonesia Demographic and Health Survey to conduct this nationally representative study. A total of 4,688 children aged 6–23 months were included in the study. MAD was classified using the 2017 World Health Organization global nutrition monitoring framework. The determinants of MAD were analyzed using multiple logistic regression.
Results Overall, 45% of children aged 6–23 months received the required MAD, with 47.4% receiving the MAD in urban areas and 35.7% in rural areas. Children’s age, fathers’ age, parents’ education level, mothers’ employment, and wealth index were strongly linked to MAD in both rural and urban homes. The factor specifically related to MAD in urban areas was mother living with her husband. For rural households, mothers’ involvement in decisionmaking and a minimum of four antenatal care (ANC) visits significantly increased the likelihood of their children’s MAD status.
Conclusion MAD status was determined by increased child age, higher parent education, younger father, working mother, and higher wealth index in children aged 6–23 months in both urban and rural settings. Mothers living with a spouse determined the MAD status only in urban areas. More frequent ANC visits and mother participation in household decisions were other factors related to MAD status in rural areas.
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Determinants of Minimum Acceptable Diet (MAD) among children aged 6 to 23 months in rural Belagavi – A cross-sectional study Ayesha Abdullatif Dhalayat, Mubashir Angolkar, Anusha Kulkarni, Alex Carvalho Clinical Epidemiology and Global Health.2026; 41: 102417. CrossRef
Health behaviors, lifestyle factors, and healthcare challenges in family medicine: a comprehensive review of recent evidence from Asian populations Joung Sik Son Korean Journal of Family Medicine.2025; 46(4): 215. CrossRef
Background Avoidable hospitalizations (AHs) are defined as hospitalizations that could have been prevented through timely and effective services. AHs are, therefore, an indicator used to evaluate the access and effectiveness of primary health care services.
Methods A retrospective time-series study spanning 8 years (2006–2013) was conducted to determine the relationship between AHs and gender, age, and access to primary health care physicians in rural areas in Tehran province, the capital of Iran. The total number of avoidable hospitalizations was 22,570; logistic regression was estimated for each year separately.
Results Total hospitalizations and AHs increased during the study period, especially during the first 3 years of the study. AHs, as a percentage of total hospitalizations, did not change significantly throughout the study years. This value was 22.3% during the first year of study and varied between 17% and 19.6% from 2007 to 2013. No statistically significant relationship was seen between AH occurrence and access to a physician during the study years.
Conclusion Increasing access to primary health care physicians cannot necessarily result in decreased AHs. Considering the factors influencing AHs while designing and implementing the family physicians program is important to achieve the expected results regarding the effectiveness of primary health care services.
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Insufficient evidence on the effectiveness of family physician program in Iran: a systematic review of existing literature Edris Kakemam, Alireza Hajizadeh, Leila Doshmangir BMC Public Health.2026;[Epub] CrossRef
Government purchasing initiatives involving private providers in the Eastern Mediterranean Region: a systematic review of impact on health service utilisation Shehla Zaidi, Jai K Das, Wafa Jamal, Ammarah Ali, Faareha Siddiqui, Aya Thabet, Hassan Salah, Awad Mataria BMJ Open.2023; 13(2): e063327. CrossRef
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