Table 3.
Associations of service density and proximity with outpatient care utilisation and their contributions to geographical inequalities
| Outpatient care utilisation |
|||||
|---|---|---|---|---|---|
|
n (%) |
SPR (95%CI) * |
Model 1 |
Model 2 |
Model 3 |
|
|
OR (95% CI) † |
OR (95% CI) ‡ |
OR (95% CI) § |
|||
|
Geographical variables | |||||
|
Type of district: | |||||
| Low-density regencies |
210 213 (32.4) |
6.60 (6.49-6.71) |
1.00 |
1.00 |
1.00 |
| High-density regencies |
314 286 (48.3) |
7.71 (7.62-7.80) |
1.11 (0.96-1.23) |
1.19 (1.02-1.39) |
1.15 (0.99-1.33) |
| Cities |
125 126 (19.3) |
9.36 (9.20-9.52) |
1.40 (1.17-1.67) |
1.36 (1.11-1.66) |
1.27 (1.04-1.55) |
|
Region: | |||||
| Java |
210 141 (32.3) |
9.11 (8.98-9.23) |
1.00 |
1.00 |
1.00 |
| Sumatra |
193 161 (29.7) |
5.31 (5.20-5.41) |
0.51 (0.38-0.68) |
0.44 (0.34-0.57) |
0.49 (0.37-0.64) |
| Bali & Nusa Tenggara |
52 378 (8.1) |
9.13 (8.88-9.38) |
0.93 (0.65-1.33) |
0.82 (0.59-1.13) |
0.90 (0.64-1.25) |
| Kalimantan |
62 283 (9.6) |
5.96 (5.76-6.15) |
0.66 (0.47-0.94) |
0.54 (0.39-0.75) |
0.60 (0.43-0.84) |
| Sulawesi |
84 271 (13.0) |
7.86 (7.67-8.03) |
0.78 (0.57-1.06) |
0.64 (0.47-0.86) |
0.67 (0.49-0.91) |
| Maluku |
19 465 (3.0) |
7.35 (6.98-7.71) |
0.84 (0.54-1.31) |
0.67 (0.44-1.03) |
0.77 (0.49-1.20) |
| Papua |
27 926 (4.3) |
13.39 (12.95-13.82) |
1.90 (1.24-2.90) |
1.56 (1.06-2.32) |
1.72 (1.15-2.60) |
|
Service density | |||||
|
GP ratio: | |||||
| Low |
252 546 (38.9) |
7.12 (7.01-7.22) |
- |
1.00 |
1.00 |
| Medium |
209 932 (32.3) |
7.28 (6.99-7.21) |
- |
0.96 (0.83-1.10) |
0.94 (0.82-1.07) |
| High |
187 147 (28.8) |
8.98 (8.78-9.02) |
- |
1.11 (0.92-1.33) |
1.05 (0.88-1.26) |
|
PHC ratio: | |||||
| Low |
279462 (43.0) |
7.88 (7.78-7.97) |
- |
1.00 |
1.00 |
| Medium |
210 576 (32.4) |
7.21 (7.09-7.31) |
- |
1.17 (1.00-1.36) |
1.13 (0.97-1.32) |
| High |
159 857 (24.6) |
7.96 (7.82-8.09) |
- |
1.22 (1.01-1.48) |
1.19 (0.98-1.43) |
|
Nurse ratio: | |||||
| Low |
260 852 (40.1) |
7.07 (6.96-7.16) |
- |
1.00 |
1.00 |
| Medium |
208 876 (32.2) |
8.07 (7.95-8.18) |
- |
1.19 (1.02-1.37) |
1.18 (1.02-1.36) |
| High |
179 897 (27.7) |
8.23 (8.09-8.34) |
- |
1.14 (0.95-1.36) |
1.13 (0.95-1.35) |
|
Service proximity | |||||
|
Travel time: | |||||
| Short |
213 713 (32.9) |
8.82 (8.70-8.94) |
- |
- |
1.00 |
| Medium |
237 623 (36.6) |
7.14 (7.04-7.24) |
- |
- |
0.94 (0.83-1.07) |
| Long |
198 289 (30.5) |
7.09 (6.98-7.20) |
- |
- |
0.88 (0.76-1.03) |
|
Travel costs: | |||||
| Low |
232 398 (35.8) |
9.30 (9.18-9.42) |
- |
- |
1.00 |
| Medium |
227 126 (35.0) |
6.54 (6.44-6.64) |
- |
- |
0.78 (0 · 70-0 · 90) |
| High |
190 101 (29.2) |
7.01 (6.89-7.13) |
- |
- |
0.82 (0 · 70-0 · 97) |
|
ICC (95% CI)‖: | |||||
| Province-level |
- |
- |
0.011 (0.005-0.024) |
0.007 (0.001-0.046) |
0.009 (0.004-0.021) |
| District-level |
- |
- |
0.088 (0.076-0.100) |
0.082 (0.072-0.094) |
0.080 (0.070-0.092) |
|
MOR (95% CrI):¶ | |||||
| Province-level |
- |
- |
1.21 (1.09-1.29) |
1.17 (1.04-1.25) |
1.17 (1.07-1.26) |
| District-level | - | - | 1.65 (1.59-1.70) | 1.63 (1.58-1.69) | 1.61 (1.56-1.67) |
SPR – standardised prevalence rate, CI – confidence interval, OR – odds ratio, GP – general practitioner, PHC – public primary health centre, ICC – intra-class correlation, MOR – median odds ratio, CrI – credible interval
*Age and sex-standardised prevalence rate, per 100 persons. †Model 1: baseline, include geographical variables adjusted to compositional factors (wealth, educational level, health insurance), age, sex, and self-assessed health status (odds ratio with 95% confidence interval).
‡Model 2: estimating the contribution of service density variables, adjusted to all variables in model 1 (odds ratio with 95% confidence interval).
§Model 3: estimating the contribution of service proximity variables, adjusted to all variables in model 2 (odds ratio with 95% confidence interval).
‖Intraclass correlation with 95% confidence interval.
¶Median odds ratio with 95% credible interval.