Table 4.
Associations of service density and proximity with inpatient care utilisation and their contributions to geographical inequalities
| Inpatient 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) |
1.53 (1.48-1.58) |
1.00 |
1.00 |
1.00 |
| High-density regencies |
314 286 (48.3) |
2.04 (1.99-2.09) |
1.16 (0.99-1.35) |
1.14 (0.98-1.33) |
1.07 (0.92-1.25) |
| Cities |
125 126 (19.3) |
2.82 (2.72-2.91) |
1.45 (1.20-1.74) |
1.23 (1.01-1.52) |
1.05 (0.85-1.30) |
|
Region: | |||||
| Java |
210 141 (32.3) |
2.38 (2.31-2.44) |
1.00 |
1.00 |
1.00 |
| Sumatra |
193 161 (29.7) |
1.51 (1.45-1.56) |
0.66 (0.49-0.89) |
0.61 (0.46-0.80) |
0.63 (0.49-0.80) |
| Bali & Nusa Tenggara |
52 378 (8.1) |
2.26 (2.13-2.28) |
1.07 (0.73-1.56) |
0.98 (0.70-1.39) |
1.02 (0.74-1.40) |
| Kalimantan |
62 283 (9.6) |
1.81 (1.69-1.91) |
0.88 (0.61-1.27) |
0.79 (0.56-1.12) |
0.85 (0.62-1.17) |
| Sulawesi |
84 271 (13.0) |
2.53 (2.42-2.63) |
1.09 (0.78-1.52) |
1.01 (0.74-1.37) |
1.06 (0.79-1.40) |
| Maluku |
19 465 (3.0) |
1.77 (1.58-1.95) |
0.86 (0.53-1.39) |
0.76 (0.49-1.20) |
0.89 (0.57-1.36) |
| Papua |
27 926 (4.3) |
1.78 (1.60-1.96) |
1.00 (0.64-1.60) |
0.87 (0.57-1.34) |
0.96 (0.64-1.44) |
|
Service density | |||||
|
Hospital beds ratio: | |||||
| Low |
252 546 (38.9) |
1.57 (1.52-1.63) |
- |
1.00 |
1.00 |
| Medium |
209 932 (32.3) |
1.88 (1.82-1.93) |
- |
1.07 (0.92-1.24) |
1.05 (0.93-1.20) |
| High |
187 147 (28.8) |
2.62 (2.56-2.69) |
- |
1.10 (0.93-1.31) |
1.23 (1.05-1.43) |
|
Nurse ratio: | |||||
| Low |
260 852 (40.1) |
1.82 (1.77-1.87) |
- |
1.00- |
1.00 |
| Medium |
208 876 (32.2) |
2.09 (2.03-2.15) |
- |
1.09 (0.96-1.25) |
1.04 (0.90-1.20) |
| High |
179 897 (27.7) |
2.27 (2.20-2.34) |
- |
1.30 (1.11-1.50) |
1.08 (0.91-1.27) |
|
Service proximity | |||||
|
Travel time: | |||||
| Short |
213 713 (32.9) |
2.64 (2.57-2.70) |
- |
- |
1.00 |
| Medium |
237 623 (36.6) |
1.95 (1.89-2.00) |
- |
- |
0.92 (0.80-1.06) |
| Long |
198 289 (30.5) |
1.42 (1.36-1.47) |
- |
- |
0.72 (0.61-0.86) |
|
Travel costs: | |||||
| Low |
232 398 (35.8) |
2.57 (2.50-2.63) |
- |
- |
1.00 |
| Medium |
227 126 (35.0) |
1.97 (1.91-2.02) |
- |
- |
0.98 (0.86-1.13) |
| High |
190 101 (29.2) |
1.41 (1.35-1.46) |
- |
- |
0.91 (0.75-1.10) |
|
ICC (95% CI)‖: | |||||
| Province-level |
- |
- |
0.013 (0.006-0.027) |
0.009 (0.003-0.022) |
0.007 (0.002-0.019) |
| District-level |
- |
- |
0.086 (0.073-0.101) |
0.081 (0.069-0.094) |
0.076 (0.065-0.088) |
|
MOR (95% CrI):¶ | |||||
| Province-level |
- |
- |
1.23 (1.04-1.31) |
1.19 (1.05-1.27) |
1.16 (1.00-1.23) |
| District-level | - | - | 1.63 (1.55-1.69) | 1.62 (1.55-1.68) | 1.60 (1.54-1.66) |
SPR – standardised prevalence rate, CI – confidence interval, OR – odds ratio, CI – confidence interval, 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.