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Indonesia's universal health scheme: one

year on, what's the verdict?
A year after the government launched a health insurance project, professionals have opposing views. Is
it too ambitious to succeed?
Lauren Razavi
Friday 15 May 2015 10.17BST

Indonesian healthcare has traditionally been fragmented: private insurance schemes for
those who could aord it, basic state provision for the very poorest, and NGOs in specialised
areas providing support in between.
However, in January last year, Indonesias government launched an ambitious project: to
establish a compulsory national health insurance system with the aim of making basic care
available to all by 2019. The scheme, Jaminan Kesehatan Nasional (JKN), was implemented
by the newly-formed social security agency Badan Penyelenggara Jaminan Sosial Kesehatan
(BPJS). It sought to improve the situation for citizens stuck in the middle of healthcare
provision too poor to aord health insurance but deemed not poor enough for government
help.
Under JKN, all citizens are now able to access a wide range of health services provided by
public facilities, as well as services from a few private organisations that have opted to join

the scheme as providers. JKN care aims to be comprehensive, covering treatment for
everyday concerns such as u through to open-heart surgery, dialysis and chemotherapy.
Private insurance continues to play a role by providing for excess or additional coverage of
services not included in JKN.
Those in formal employment pay a premium equivalent to 5% of their salary, with 4%
payable by employers and 1% payable by employees. Informal workers, the self-employed
and investors pay xed monthly premiums of between 25,500 IDR (1.34) and 59,500 IDR
(3.12) in a tiered system of rst, second and third-rate care depending on the contributions
they choose to pay.
However, more than a year on, the JKN scheme has been subject to intense criticism.
Academic studies by the Gadjah Mada University Centre for Health and the Paramadina
Graduate School of Diplomacy have concluded that it will be impossible for all Indonesian
citizens to access health insurance by 2019, as the BPJS had projected. The plan is too
ambitious, says Yaslis Ilyas, a public health analyst at the University of Indonesia and critic
of the project.
The issue of unequal access lies at the heart of the debate largely a result of problems with
the administration of the scheme. Personnel have low competency and the JKN
management has been ineective, Ilyas believes. In addition, the population of jobless
people and those working in the informal sector in Indonesia is very high.
The scheme has been less eective in areas where visiting a clinic or hospital involves long
and sometimes expensive journeys to urban areas. This lack of infrastructure has meant
that the scheme has been far from universal during its rst 15 months.
For those citizens who are unemployed or work in the informal sector in Indonesia, NGOs
have historically been the ones to plug the gaps in healthcare provision. The John Fawcett
Foundation, for example, an NGO treating preventable blindness, works in the poorest and
hardest-to-reach parts of Indonesia.
It is these areas that have struggled to gain access to healthcare through the JKN scheme so
far. Communication and transportation are denitely big problems for healthcare access
under JKN, especially for those who live in remote areas or islands, Ilyas explains.
Some local people, especially in cities, are also sceptical about the programmes benets.
JKN has denitely not been entirely successful. It has been extensively advertised in the
media, and many people are talking about it, but anybody with money would not use it,
says Kiki Handayani, 38, who has lived and worked in both Bali and Jakarta over the past
few years, and whose father enrolled in the JKN scheme last year.
Its easy enough to register you provide ID, employment details and a photograph, then
you receive a card. But many people complain that it does not provide the service
promised, Handayani adds.
However, Irfan Humaidi, speaking for BPJS Kesehatan who supply the new healthcare

service, robustly defends it. In the rst year of the social health insurance implementation,
BPJS achieved a membership of 133.4 million when the target was 121.6 million, and BPJS
has already paid the claims submitted by hospitals [as a result of the scheme], he says.
Based on an independent survey, customer satisfaction is 81% and awareness of the new
social health insurance system is 95%. Complaints have been resolved within 1.5 days on
average. Just a year after implementation, we have made many important achievements for
the nation, he adds.
And despite the criticisms, many still have high hopes for the programme. Our sta are
very optimistic about the BPJS scheme, said Mary Northmore-Aziz, founder and chair of
the Bali Smile Foundation, an NGO that helps people with craniofacial disabilities obtain
healthcare. They know its a big undertaking but seem very optimistic about its impact on
their lives. A husband received good quality heart care for free in our local public hospital.
Others are delighted that their families will be covered, so private arrangements wont be
needed.
While the JKN scheme is, in principle at least, an improvement for some sections of
Indonesian society, it still has a long way to go if it is to become truly universal by 2019.
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Topics
Transforming institutions Indonesia Health Asia Pacic
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