Universal Health Coverage and Health Care Financing Indonesia

Universal health coverage is defined as ensuring that all people have access to needed promotion, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services. Universal health coverage has therefore become a major goal for health reform in many countries and a priority objective of WHO.

Six facts of Indonesia’s UHC/JKN (jaminan kesehatan nasional):

  • Based on Law No. 40/2004 on National Social Security System, and Law No. 24/2011 on Social Security Administrative Agencies. Further, JKN was backed up with the following implementation regulations:
    • Government Regulation/PP No. 12/2013 on Health Security
    • Minister of Health Decree No. 69/2013 on Tariff Standard at Primary and Referral Healthcare Facilities
    • Minister of Health Decree No. 71/2013 on Healthcare Services in JKN
    • Minister of Health Decree No. 382/2013 on National Formulary.
  • The Indonesia’s UHC/JKN was launched on 1 January 2014 to initially cover around 120 M population who are already engaged in various social health insurance (SHI) schemes under one fund-management agency called Health-BPJS. The targeted all population coverage is around 250 M people to be covered by 2019. With the targeted coverage, JKN will be the the world largest SHI.
  • The 120 million members of 2014 consist of 86,4 million ex-members of SHI for the poor (Jamkesmas) with premium sponsored by Government, 35 million ex-members of civil servant SHI (PT Askes) and formal workers’ SHI (PT Jamsostek) etc.
  • 126 M members (over the targeted 120 M) has been achieved by August 2014, with 18.355 contracted health facilities, consisting of 16804 primary care facilities and 1551 hospitals.
  • Four specific objectives of JKN (as stated by Minister of Health 280814):
    • To enable people accessing healthcare services without financial hardship
    • To perform cost contained and quality controlled healthcare services.
    • To strengthen healthcare services at primary and referral health facilities
    • To prioritize preventive and promotive measures in rendering healthcare services to reduce prevalence of diseases, lower the numbers of sick-people with efficient healthcare services.
  • Main JKN issues raised in 2014 include:
    • Availability and equitable distribution of health services in outer islands to serve JKN members and overall quality of healthcare services (See Supply Site Readiness, WB 2014)
    • Provider payment: issues with long time laps for government primary care facilities in receiving capitation payment due to regulation on decentralization; and low tariff set in INA-CBG prospective payment.
    • Lack of JKN socialization activities for the people at large and coverage issues of people in the informal sectors.
    • Assurance of sustainable financing towards UHC.

WHO Indonesia focus on:

  • UHC capacity building of middle management officials at MoH, BPJS, Bappenas, MoF, etc
  • Monitoring-evaluation and assessment of UHC implementation at national and subnational levels in collaboration with universities and research centres for policy development inputs
  • NHA training, institutionalization and annual production
  • Development of clinical governance and clinical pathway guidelines to help improve quality healthcare internal processes and provider payment system.

Key Partners for UHC / UHF:

  • MoH (P2JK, NIHRD, DG for Medical
  • BPJS and DJSN, Bappenas
  • Universities (UI, Unhas, UGM etc)
  • Professional associations
  • UN agencies and the World Bank
  • Development partners (Ausaid, USAID, GIZ)