On Thursday, January 2, 2025, the Doctoral Program in Public Health Sciences at the Faculty of Public Health (FPH) of the Universitas Indonesia (UI) held an Open Doctoral Promotion Session for Marsaulina Olivia Panjaitan. The session was chaired by Prof. Dr. dr. Sabarinah, M.Sc., with Prof. dr. Amal Chalik Sjaaf, S.K.M., Dr. PH., as the Promoter, and Prof. dr. Anhari Achadi, S.K.M., Sc.D., and Prof. Dr. dr. Dwiana Ocviyanti, SpOG (K), M.P.H., as Co-Promoters. The examination committee consisted of Prof. Dr. drg. Mardiati Nadjib, M.S.; Dr. Pujiyanto, S.K.M., M.Kes.; Dr. Atik Nurwahyuni, S.K.M., M.Kes.; Dr. dr. Supriyantoro, Sp.P., MARS.; and Dr. dr. Chairul Radjab Nasution, Sp.PD., KGEH., FINASIM., FACP., M.Kes. Marsaulina Olivia Panjaitan defended her dissertation entitled “Analysis of Alternative Policies for Controlling the Utilization of Cesarean Section in the National Health Insurance Program (Case Study in 2019 at Three Hospitals in Jakarta Province).”
In the implementation of the National Health Insurance Program, Cesarean Section (C-section) has the highest CBGs code based on the ten most frequent CBGs in Advanced Inpatient Care, with the number of cases and costs continuously increasing every year. In 2018, Cesarean Delivery accounted for the highest proportion of maternal spending, which was 74% of the total delivery costs in FKTP and FKRTL. The increase in healthcare utilization leads to higher costs in the implementation of the National Health Insurance Program. This results in ongoing challenges for the National Health Insurance program in Indonesia to maintain the sustainability of its financing.
This dissertation aimed to analyze policies and propose policy recommendations to control the utilization of Cesarean Section procedures within the National Health Insurance Program. The research used an analytical mixed-method approach and policy analysis based on Eugene Bardach’s eightfold framework, modified by Collins.
The research conducted by Marsaulina Olivia Panjaitan identified the factors influencing cesarean deliveries and the current policies controlling Cesarean Section utilization at both the hospital and national levels. Based on the policy analysis using the modified Bardach’s eightfold framework, alternative policy scenarios for controlling Cesarean Section utilization were developed. These alternatives included strengthening FKTPs for controlling Cesarean deliveries, so the control of utilization does not only occur at hospitals. It also involved formulating a national policy for controlling Cesarean deliveries, particularly for first-time pregnant women, based on local and national surveillance results. This is important to ensure that promotive and preventive programs are appropriately targeted to minimize the risks of pregnancy complications that could lead to Cesarean deliveries, especially in first-time pregnancies that may lead to Cesareans in subsequent pregnancies.
Based on the findings of her dissertation, Marsaulina Olivia Panjaitan was officially awarded a Doctorate in Public Health Sciences with a highly satisfactory graduation result. Marsaulina Olivia Panjaitan is the first doctoral graduate in Public Health Sciences in 2025, the 340th doctoral graduate in Public Health Sciences, and the 437th doctoral graduate of FPH UI. (Promovendus)