FK-KMK UGM. The Center for Health Policy and Management (PKMK) of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (FK-KMK UGM), recently concluded a webinar series titled “10 Years of JKN Policy in 3 Periods” held on December 16, 18, and 30, 2024. The event featured policy experts, researchers, and healthcare practitioners to evaluate a decade of the National Health Insurance (JKN) implementation in Indonesia.
The webinars served as a critical reflection on JKN, the world’s largest single-pooling health insurance system. Since its implementation in 2014, JKN has covered 83% of Indonesia’s population by 2021. However, challenges remain, especially concerning equitable access and quality of healthcare services.
Prof. dr. Laksono Trisnantoro, MSc, PhD, Chair of PKMK FK-KMK UGM, highlighted the paradoxes within JKN’s implementation. Despite high Universal Health Coverage (UHC) rates, service disparities persist in several regions, particularly remote areas such as East Nusa Tenggara (NTT).
“The lack of absorption isn’t because people are healthy; it’s because they have no access. For instance, in NTT, heart surgery services are unavailable,” Prof. Laksono explained during a press conference.
He also pointed out that healthcare services are often enjoyed by middle-to-upper-class individuals who could afford commercial insurance, further underscoring inequity.
The webinar delved into three major phases of JKN implementation: the pre-pandemic era (2014-2019), the COVID-19 pandemic period (2020-2022), and the post-pandemic era (2023-present). During the pre-pandemic period, JKN faced challenges in ensuring fairness and quality in healthcare services. Fraud prevention systems, established in 2015, yielded limited results, while in-depth analysis based on BPJS membership segmentation had not yet been conducted.
The COVID-19 pandemic brought significant changes to health funding systems. Funds from the National Economic Recovery (PEN) policy were allocated to cover COVID-19 patient treatment costs, creating a temporary surplus for BPJS. However, this situation could not be considered a genuine reflection of the JKN system due to the influence of additional funding.
In the post-pandemic era, pre-COVID financial deficits have resurfaced, particularly within BPJS segments. Prof. Laksono noted that many BPJS members only activate their accounts when they require medical services but cease payments after recovery.
“The largest deficits come from the BPO segment, where members use BPJS because they are already sick. Once treated and recovered, they stop paying,” he added.
Currently, approximately 25 million individuals are registered but inactive, while 4 million others have yet to join BPJS.
As a solution, Prof. Laksono emphasized the need for more targeted policies to address the weaknesses in the JKN system. He stressed the importance of a thorough evaluation of the JKN Law and the implementation of segmentation-based policies.
“We at UGM are not aiming to provoke but rather to stimulate awareness that there might be issues with the law, which cannot be resolved through ordinary regulations,” he said.
The webinar also produced several strategic recommendations to enhance JKN’s sustainability. These include strengthening quality control systems, safeguarding the funding of Contribution Assistance Recipients (PBI) for low-income populations, and fostering synergy between central and local governments and the private sector in developing healthcare infrastructure. Encouraging the middle-to-upper class to rely less on JKN and switch to commercial insurance was also deemed crucial.
Moreover, Prof. Laksono stressed that government funds should be prioritized for the poor, in line with the principles of Pancasila.
“Abroad, people allocate 5% of their income for insurance. Here, whether you’re rich or poor, it’s just IDR 150,000,” he explained.
This highlights the need for policies rooted in social justice to achieve true UHC. The webinar series marked the initial step for PKMK FK-KMK UGM in drafting policy briefs involving various stakeholders.
The discussions aim to provide valuable input for the government in crafting more inclusive and sustainable health policies. As Prof. Laksono stated, “We’ve had hundreds of meetings to prepare policy briefs with relevant stakeholders.”
These efforts are expected to foster a more equitable and accessible healthcare system in the future.
Through these recommendations, PKMK FK-KMK UGM remains committed to supporting the achievement of the Sustainable Development Goals (SDGs), including Good Health and Well-being (SDG 3), Quality Education (SDG 4), Industry, Innovation, and Infrastructure (SDG 9), Reduced Inequalities (SDG 10), Responsible Consumption and Production (SDG 12), and Partnerships for the Goals (SDG 17). (Isroq Adi Subakti/Reporter).
