Explaining Indonesian Patients’ Experiences About Changes in the Hemodialysis Cost System
Authors: Lailatun Nimah  , Nursalam Nursalam , Andri Setiya Wahyudi  , Herdina Mariyanti  , Duangporn Piyakong  
Published: February 2025

Aim: To explore the experience of haemodialysis patients in Indonesia over a decade, amidst changes in the cost system in hospitals. Since its implementation, the Universal Health Coverage (UHC) policy has significantly influenced haemodialysis services in hospitals, affecting patients' experiences.
Material and Methods: Qualitative study. Twenty-two haemodialysis patients selected by snowball sampling from the Indonesian Dialysis Patient Community (Komunitas Pasien Cuci Darah Indonesia) participated. Data were collected through interviews, transcribed and analysed thematically, and psychological methods based on patients' experiences were used.
Results: identified three main themes (health coverage system, haemodialysis services, haemodialysis facilities) and ten sub-themes (complex monthly payment situation for care recipients, unexpected deactivation of payment status, outdated referral system requirements, payment system complications for care recipients, penalty for late payments, disparities in services between hospitals, insufficient coverage for certain services, accessibility problems with distant haemodialysis units, variations in types of haemodialysis equipment, and inadequate comfort in the family waiting room).
Conclusions: The health insurance system needs to be improved to increase access, equity, affordability, efficiency, consistency and quality of haemodialysis services in Indonesian hospitals. Collaborative efforts by the government, health institutions and related parties are essential.

Objetivo: explorar la experiencia de los pacientes de hemodiálisis en Indonesia durante una década, en medio de cambios en el sistema de costos en los hospitales. Desde su implementación, la política de Cobertura Sanitaria Universal (CSU) ha influido significativamente en los servicios de hemodiálisis en los hospitales, afectando a las experiencias de los pacientes. 
Material y Métodos: Estudio cualitativo. Participaron veintidós pacientes de hemodiálisis seleccionados mediante un muestreo por bola de nieve de la Comunidad de Pacientes de Diálisis de Indonesia (Komunitas Pasien Cuci Darah Indonesia). Los datos se recopilaron mediante entrevistas, se transcribieron y analizaron temáticamente y se utilizaron métodos psicológicos basados en las experiencias de los pacientes.
Resultados: identificados tres temas principales (sistema de cobertura de salud, servicios de hemodiálisis, instalaciones de hemodiálisis) y diez subtemas (situación de pago mensual compleja para los beneficiarios de asistencia, desactivación inesperada del estado de pago, requisitos del sistema de referencia obsoletos, complicaciones en el sistema de pago para los beneficiarios de asistencia, penalización por pagos atrasados, disparidades en los servicios entre hospitales, cobertura insuficiente para ciertos servicios, problemas de accesibilidad con unidades de hemodiálisis distantes, variaciones en los tipos de equipos de hemodiálisis y comodidad inadecuada en la sala de espera familiar).
Conclusiones:  necesario mejorar el sistema de seguro de salud para aumentar el acceso, la equidad, la asequibilidad, la eficiencia, la uniformidad y la calidad de los servicios de hemodiálisis en los hospitales de Indonesia. Imprescindible que el gobierno, las instituciones sanitarias y las partes relacionadas realicen esfuerzos de colaboración.

Objective: Since its implementation in 2014, the Universal Health Coverage (UHC) policy in Indonesia has significantly influenced hemodialysis services in hospitals, impacting patient experiences. This study aims to explore the experience of patients with hemodialysis over a decade amid changes in the hospital hemodialysis cost system. Method: This is a qualitative study. This research involved twenty-two hemodialysis patients selected through snowball sampling from the Indonesian Dialysis Patients Community (Komunitas Pasien Cuci Darah Indonesia). The data were collected through semi-structured, in-depth, face-to-face interviews, transcribed and analyzed using the thematic method. Results: The study identified three main themes (Health coverage system, hemodialysis services, hemodialysis facilities) and ten subthemes (complex monthly payment situation for assistance beneficiaries, unexpected deactivation of payment status, outdated requirements of the referral system). , complications in the system of payment of assistance to beneficiaries, penalties for late payments, disparities in services between hospitals, insufficient coverage for certain services, accessibility problems with distant hemodialysis units, variations in the types of hemodialysis equipment and inadequate comfort in the room family waiting list). Conclusions: The results highlight the needs for improvement in the health insurance system to improve access, fairness, accessibility, efficiency, consistency and quality of hemodialysis services in Indonesian hospitals. Collaborative efforts involving government, health institutions and related parties are imperative to meet these challenges.