The Impact of the Indonesian National Health Insurance Implementation on Prostate Cancer Detection, Staging, and Treatment in West Java Province, Indonesia.

BACKGROUND

This study aimed to evaluate the impact of National Health Insurance/ Jaminan Kesehatan Nasional (JKN) implementation on prostate cancer detection, staging, and treatment in West Java Province, Indonesia, with a focus on changes in prostate-specific antigen (PSA) testing accessibility.

METHODS

This cross-sectional study retrospectively analyzed medical records from Hasan Sadikin Hospital, a tertiary referral center, to compare prostate cancer cases between 2009-2013 (pre-JKN) and 2015-2019 (post-JKN). Data included age at diagnosis, PSA levels, Gleason grade, T and M stages, and treatment modalities. Additionally, a survey of urologists in West Java was conducted to assess PSA testing practices and JKN coverage. Statistical analyses were performed using Chi-square and Mann-Whitney U-tests.

RESULTS

Following JKN implementation, a significant increase in median PSA levels (from 29.275 ng/ml to 85.845 ng/ml, p=0.002) was observed. This was accompanied by a shift towards higher Gleason grade groups (p<0.001), more advanced T stages (p<0.001), and advanced M stages (p=0.003). The survey revealed limited PSA testing coverage under JKN, with only 18.75% of urologists reporting availability at their hospitals.

CONCLUSION

Limited PSA testing following JKN implementation resulted in an increase in median PSA levels and a shift toward more advanced disease, suggesting an inability to detect prostate cancer at an early stage. These findings underscore the urgent need for targeted policy adjustments to enhance early detection, particularly in primary care settings.