Background
This study investigates disparities in the utilization of primary health care (PHC) between urban and rural populations in Indonesia, focusing on socioeconomic and demographic determinants. Understanding these patterns is essential for promoting equity under the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program.
Methods
Data were obtained from the 2023 National Socioeconomic Survey, which included 334,887 individuals. Binary logistic regression was used to examine the association between individual characteristics and PHC utilization.
Results
Overall utilization rates were similar across urban and rural areas, but significant disparities were observed. Women were more likely to use PHC than men (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.10–1.13). The association between higher education and PHC utilization was negative (OR, 0.78; 95% CI, 0.75–0.81), while access to information technology slightly reduced utilization (OR, 0.98; 95% CI, 0.96–0.99). Wealth effects diverged sharply: affluent urban residents were less likely to use PHC (OR, 0.84; 95% CI, 0.81–0.87), whereas wealthier rural residents were more likely to utilize PHC (OR, 1.09; 95% CI, 1.05–1.13). Dual insurance ownership had a strong positive effect in rural areas (OR, 1.56; 95% CI, 1.25–1.94).
Conclusion
These findings highlight structural inequalities in PHC utilization. Policy efforts must prioritize enhancing the quality and attractiveness of PHC in urban areas, improving financial protection and infrastructure in rural areas, and addressing the digital divide. Such targeted measures are essential for achieving equitable and inclusive health coverage under JKN.

Background
Avoidable hospitalizations (AHs) are defined as hospitalizations that could have been prevented through timely and effective services. AHs are, therefore, an indicator used to evaluate the access and effectiveness of primary health care services.
Methods
A retrospective time-series study spanning 8 years (2006–2013) was conducted to determine the relationship between AHs and gender, age, and access to primary health care physicians in rural areas in Tehran province, the capital of Iran. The total number of avoidable hospitalizations was 22,570; logistic regression was estimated for each year separately.
Results
Total hospitalizations and AHs increased during the study period, especially during the first 3 years of the study. AHs, as a percentage of total hospitalizations, did not change significantly throughout the study years. This value was 22.3% during the first year of study and varied between 17% and 19.6% from 2007 to 2013. No statistically significant relationship was seen between AH occurrence and access to a physician during the study years.
Conclusion
Increasing access to primary health care physicians cannot necessarily result in decreased AHs. Considering the factors influencing AHs while designing and implementing the family physicians program is important to achieve the expected results regarding the effectiveness of primary health care services.

Citations

• Insufficient evidence on the effectiveness of family physician program in Iran: a systematic review of existing literature
  Edris Kakemam, Alireza Hajizadeh, Leila Doshmangir
  BMC Public Health.2026;[Epub]     CrossRef
• Government purchasing initiatives involving private providers in the Eastern Mediterranean Region: a systematic review of impact on health service utilisation
  Shehla Zaidi, Jai K Das, Wafa Jamal, Ammarah Ali, Faareha Siddiqui, Aya Thabet, Hassan Salah, Awad Mataria
  BMJ Open.2023; 13(2): e063327.     CrossRef