Endometriosis healthcare access in Indonesia based on the Indonesian national health insurance data in 2020-2023

Abstract: Endometriosis, with a global prevalence of approximately 18%, is a chronic condition that significantly impacts patients' quality of life and increases the risk of depression. Despite growing public health concerns, access to healthcare for endometriosis patients remains inadequate worldwide. This study aims to evaluate healthcare access in Indonesia, focusing on endometriosis care across regions and considering factors such as age, marital status, and health insurance participation. This cross-sectional study employs secondary data analysis of visitation records from the Social Security Agency for Health (BPJS Kesehatan) Indonesia in 2020-2023. Logistic regression was used to determine disparities in endometriosis care across regions and other related factors. We identified 1,974 visits from patients with a primary diagnosis of endometriosis (N.80) and 306 individuals who had multiple visits within our data time frame. Our analysis found that endometriosis care in Indonesia is affected by the type of services provided and NIH participation, as well as by region. Patients in the lowest class of service had the least access to endometriosis therapy compared to those in the higher class. Patients living in Kalimantan, despite having more visits (OR=1.92 [1.26-2.94]), are less likely to receive therapeutic management (laparoscopy, non-laparoscopy surgery, or non-surgical treatment) than those living in Java and Bali. This study reveals disparities in endometriosis healthcare access in Indonesia, underscoring the urgent need to increase the number of OB/GYNs and improve hospital quality, particularly in regions outside Java and Bali, to ensure equitable access for all endometriosis patients nationwide. Lay summary: Endometriosis affects 18% of women globally, yet diagnosis and treatment delays remain widespread. In Indonesia, this study reveals stark disparities in access to endometriosis care. Even with national health insurance implemented, access to care remains affected by the class of service to which patients are entitled, with those in the lowest class having the least access to endometriosis therapy. Patients living in Kalimantan, despite having more visits, are less likely to have access to endometriosis therapeutic management, such as laparoscopy, non-laparoscopy surgery, and non-surgical care, than those living in Java and Bali. These findings highlight urgent inequities in Indonesia's healthcare system, where a limited number of OB/GYN specialists and referral hospitals deprive women-particularly in remote areas-of optimal care. Addressing these gaps through policy reforms and equitable resource distribution is critical to improving endometriosis management and women's health nationwide.