Lessons from the Far East: Indonesia's progress toward universal health coverage

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by Suneeta Sharma, Sayaka Koseki, and Shreeshant Prabhakaran

Universal health coverage and health insurance has been on top of many people’s minds lately. National governments large and small, developing and developed alike are considering the most efficient and effective ways to provide quality healthcare for all. In Indonesia, the fourth most populous nation in the world, the government initiated its national health insurance scheme Jaminan Kesehatan Nasional (or JKN for short) in January 2014, aiming to cover 95% of its population by 2019. With over 260 million people scattered across 6,000+ inhabited islands, providing universal access to affordable, timely, high-quality healthcare equitably is no small feat.

Indonesia has seen strong economic growth and the government has the financial resources to dedicate to such a large-scale national health insurance scheme. Also, and potentially more importantly, the political will to achieve full health insurance coverage is clear, with the President being a major advocate. Three years into the program, the government has already enrolled almost 70% of its population. Of course, implementation of the scheme has not always been seamless, but there is much the international community can learn from their experience.

Through our work on the USAID-funded Health Policy Plus (HP+) project, we have been collaborating with the Government of Indonesia’s National Team for the Acceleration of Poverty Reduction (TNP2K) to conduct a comprehensive assessment of JKN. TNP2K and HP+, with the Indonesian National Social Security Council, held a session at the International Health Economics Association conference in Boston, Massachusetts, last month to share some of our current analysis. I was excited to see so many Indonesian government officials and academic researchers at the conference sharing their insights as well. This highlights the growth in international interest on Indonesia’s progress in health financing reforms, as well as the quality of analysis being conducted by Indonesian researchers and implementers. Overall, the findings presented were encouraging, for example:

  • JKN benefits the poor. JKN is relieving the financial burden of accessing health care for the poor. The Government of Indonesia’s annual household survey shows that they are using health services more frequently since the roll-out of JKN. While they still use care less than the non-poor, this difference is decreasing, which is a good sign.
  • Rural women are accessing essential, life-saving services with JKN. Pregnant women from eastern, more rural provinces in Indonesia with JKN coverage are delivering their babies at the hands of skilled medical professionals. Sub-national governments are investing in programs complementary to JKN to ensure that communities are aware of the importance of facility-based delivery and that clinics have the human resources and skills to identify complications early. This is also a positive sign given the stagnation in maternal mortality reduction among the poor and vulnerable groups.
  • There remain ways to strengthen quality of care while reducing cost. For example, one study showed that regulatory changes could lower the length of stay at hospitals and reduce the number of re-admissions. Another showed that payment incentives can control the cost of excessive referrals. Data brings knowledge, and analyses like these demonstrate the government’s efforts to continually seek to improve the performance of the scheme.

It is exciting to see the way the Indonesian government, local institutions, and researchers are proactively working to solve issues and strengthen the scheme. In particular, we find the government’s continued focus on ensuring the poor are benefiting from its implementation impressive. There is more to be done in this path toward universal health coverage. For example, HP+ is working with TNP2K to inform how the scheme could sustainably scale up by incentivizing competition while remaining pro-poor. Stay tuned as more insights emerge from this dynamic Southeast Asian archipelago as it strives toward universal health coverage.

Suneeta Sharma is Vice President, Health Practice at Palladium and the Director of the USAID-funded Health Policy Plus (HP+) project. Sayaka Koseki is Country Activity Manager, Indonesia at Palladium on HP+. Shreeshant Prabhakaran is Technical Advisor, Health Finance at Palladium on HP+.

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