Indonesia on the way to universal health coverage: a first year review

Indonesia National Health Insurance (JKN)

Jaminan Kesehatan Nasional (JKN) is a national health insurance scheme launched by Indonesia in 2014. It covers 157 million people today and aims to provide universal health coverage to the whole population by 2019. What are the options to address JKN’s main challenges of financial sustainability and coverage effectiveness?

The JKN policy design and implementation have made remarkable progress in the first years, but naturally a reform of such a scope faces multiple challenges on the way. Some of the main questions concern the financial status of the scheme as well as its performance in terms of financial protection of JKN members. To have a better understanding of the reform status and derive recommendations for the Indonesian policy makers, a study titled "Financial Sustainability and Coverage Effectiveness of the JKN Programme: A First Year Review" was conducted in 2015. The policy briefs present the key findings of the study and an outlook for policy options ahead.

Policy Brief 1: Financial Sustainability of the National Health Insurance in Indonesia: A First Year Review

Title page JKN publication

In 2014 the JKN scheme exhibited a rather large financial deficit with a medical claim ratio of 115%. This policy brief presents an assessment of the medium-term financial sustainability of JKN over the next five years. In our actuarial analysis and projection of health service claim data we assume that there will be an increase in the number of JKN members, increased utilisation of health care services and moderately higher health care unit costs. Based on these assumptions, we project that the deficit incurred in 2014 will continue to grow in the next few years and that this trend may jeopardise the health insurance scheme.

One short-term solution should be a re-evaluation and adjustment of the contribution rates. However, restoring a dynamic equilibrium between revenue and expenditure cannot solely rely on increasing revenues. To ensure the financial sustainability of JKN, a careful scrutiny of multiple factors, such as health care unit prices, and the implementation of reasonable cost-containment measures are necessary.

Policy Brief 2: Out-of-Pocket Payments in the National Health Insurance of Indonesia: A First Year Review

Title page OOP publication

This policy brief presents recent evidence on the scheme’s coverage effectiveness and the financial protection provided to JKN members. We conducted an empirical assessment of out-of-pocket (OOP) health payments incurred by JKN-insured patients in health facilities. The results show that on average, in 18% of cases patients still make OOP payments. Patients form households classified as poor suffer from the highest burden of OOP health spending (relative to their income). The major cost driver of OOP spending among various hospital services are medicines that patients purchase privately. Further details and policy options for policy makers to address the challenge of persistent OOP spending are presented below.

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