Quantifying the Effectiveness of Health Insurance in Reducing Home Births: Evidence from the 2023 Indonesia Health Survey

Objective: To assess the association between different types of health insurance (National Health Insurance [NHI], private, and mixed) and the likelihood of home delivery among women in Indonesia.Material and Methods: This secondary analysis used data from the 2023 Indonesia Health Survey, including 70,916 women who had given birth in the past five years. Home delivery was the outcome, and health insurance ownership (uninsured, NHI, private, mixed) was the exposure. Eight covariates were included. Binary logistic regression was used to estimate associations across individuals, with uninsured women as the reference group, and the results were reported as adjusted odds ratios (AORs) and 95% confidence intervals (CI).Results: The prevalence of home delivery was 7.2%, and 22.7% of women were uninsured. Compared with uninsured women, those with NHI (AOR 2.218; 95% CI 2.210–2.226; p-value<0.001), private insurance (AOR 1.790; 95% CI 1.758–1.822; p-value<0.001), and mixed coverage (AOR 4.237; 95% CI 4.054–4.429; p-value<0.001) had significantly higher odds of facility-based delivery. Timely antenatal care was also strongly associated with reduced home delivery (AOR 2.330; 95% CI 2.322–2.339; p-value<0.001). Socioeconomic disparities persisted, with a higher likelihood of home delivery among women who were poorer, less educated, and living in rural areas.Conclusion: Health insurance coverage was associated with a lower likelihood of home delivery in Indonesia, especially among women with mixed insurance coverage. Nonetheless, the observed relationships should be interpreted as associations rather than causal effects.