Underutilize Even Free

Jamkesmas Effect

In Economic concepts, it is clear that demand is influence by price. Demand will continue to rise if price continues to move down, or even free. This theory seems match with phenomena in Indonesia. Since 2005, 36.1 million poor and near poor people in Indonesia already covered by health insurance. The government gives premium assistance as a whole with comprehensive benefits and no or minimal cost sharing. Aim of this program is to of poor communities improve access to health facilities and health status. Currently the government has to protect the 76.4 million poor and near poor, this figure more than the number of poor in Indonesia. This means Jamkesmas has protected the people of Indonesia for 30.3% of the total population of Indonesia in 2010 or 53.7% from 60.24% Indonesia people that are protected by health insurance.

Initial impact of this program already felt from the beginning. Average increase utilization of special health services in the diagnosis of open fracture reduction per year from 2005 to 2007 is 1,665%,followed by cardiac surgery at 743%. Although on the other hand there is a decrease in cancer surgery by 17%. Since 2007 until 2010, the target number of participants Jamkesmas is 76.4 million. Trend use of health insurance from 2007 through 2010 which can be seen in Figure 1. Utilization of outpatient and inpatient health services by the poor and near poor rose sharply. Average increase of utilization from 2007 to 2010 reached more than 128% for outpatient care and 7% inpatient care. Roughly, the average of utilization rate from 2007 to 2010 for outpatient care was 2.5% and 0.2% per month of the total participants Jamkesmas (76.4 million people). This shows of low Jamkesmas utilization even though it was ​​free. Therefore it is no surprised that IDR 5.5 trillion of budget 2011, or 6,000 IDR / per capita / per month in 2011 was enough to provide comprehensive benefits.

Table 1. Special Health Services Cases, Year 2005-2007



2006 2007









Cardiac surgery












Cancer surgery




Open reduction fracture




Source: 1


Figure 1. Numbers of Visits Jamkesmas Numbers of visits Participants Jamkesmas, Year 2007-2010 Year 2007-2010

Source: 2

What Factors Using Jamkesmas?

In Nan Sabaris Pariaman District in 2006, utilization of delivery by health staff has reached 68.2%. Askeskin ownership has increased 6 times a person to the maternity health professionals3. But in national level, Jamkesmas card utilization of antenatal care (ANC), pregnant women were referred, assisted childbirth and psot natal care in health centers in 2010 is still low. Jamkesmas utilization by pregnant women for ANC is 554,034 visits (4.8%) of the total population of pregnant women. Poor and near poor of pregnant women who are using Jamkesmas to ANC is 34.53% only. Utilization Jamkesmas for delivery by health staff is 368,088 visits (1%) of total maternal targets, It means that only 23.97% of poor and near-poor pregnant women who use Jamkesmas4.

The average utilization of outpatient clinic in Primary Health Care (Puskesmas) by Jamkesmas patients in Gorontalo city in 2007-2008 was below the national target (15%). Jamkesmas participants in Gorontalo city who utilize health services only 38.03%. The triggers of why participants did not utilize Jamkesmas are they still have a belief that disease is caused by spirits, knowledge of Jamkesmas, difficult geographic access, cost and lack of transportation facilities and people do not satisfy due to no health staff in Puskesmas and Primary Health Care Satelite (Pustu). Jamkesmas participants tend to go to health care if the illness was already getting worse5. The same thing also found from the Suryawan (2008) research result. Utilization by Askeskin participants at the Buleleng Puskesmas was still low (average 1.65% per month). It was caused by the perception of pain and poor quality of health centers6.

Utilization rate of the poor and near poor people who receive health care at the Simpang Pandan Puskesmas was likely to increase, but still in the low category. The most dominant factors associated with utilization of health services is the knowledge of Jamkesmas services and how to access the services.7

The results of another study conducted by Mariana (2009), the utilization rate Jamkesmas participants in the Tanah Laut District, especially Puskesmas were still far from the expected and evendecreased by 6.23% in 2006 to 3.49% in 2007. Ease of access to health facilities and the severity of disease was the determinants 8.

On the other hand, it is undeniable that quality of health care is one of the most important indicator. Learning from Vietnam, people did not want to get the services for free. Instead, the demand rises when there are user fees. Here aparently the price serves as an indicator for the quality of the product.9 Even the users cannot judge the quality due to asymetric information. Again, this shows us the limits of "normal" economic theory in analyzing supply and demand for health care.


Free health care programs that have been launched since 2005 was an innovative program that should be appreciated. Improved access to health services by the poor and near poor people increased sharply from year to year. But the increased of using Jamkesmas still below the target expected. Many other factors that predispose a person to utilize Jamkesmas. These are:

(1) Faith and knowledge on health, where there is still a belief in the occult and not going to health facility before get worse;

(2) Low Knowledge about Jamkesmas service

(3) Ease of access to health facilities, either because of geographical problems which cause difficulty obtaining transportation facilities and the high cost of transportation to health facilities;

(4) Poor perception of service quality in health facilities.

Based on various factors above, it looks that there are still a lot of homework to improve knowledge continuously of health through education and health promotion, dissemination of information and distribution of Jamkesmas cards, quality improvement in health services and last but not least, improving access to health care both in terms of transportation and health services supply aspect..


1. Mukti AG. Sistem Jaminan Kesehatan Konsep Desentralisasi Terintegrasi. Yogyakarta: KPMAK – UGM; 2007.

2. Kemenkes-RI. Profil Kesehatan Indonesia 2010. Jakarta: Kemenkes-RI; 2011.

3. Zairil. Hubungan Kepemilikan Askeskin Dengan Utilisasi Persalinan Oleh Tenaga Kesehatan Di Kecamatan Nan Sabaris Kabupaten Padang Pariaman Yogyakarta: Universitas Gadjah Mada; 2008.

4. Pusat Data dan Informasi. Analisis Data Laporan Jamkesmas 2010. Buletin Jendela Data dan Informasi Kesehatan. Jakarta: Kemenkes-RI; 2011. p. 3-25.

5. Panu NE. Perilaku Pencarian Pelayanan Kesehatan Peserta Jaminan Kesehatan Masyarakat (jamkesmas) Di Kota Gorontalo. Yogyakarta: Universitas Gadjah Mada; 2010.

6. Suaryawan IG. Hambatan Dalam Utilisasi Pelayanan Kesehatan Puskesmas Buleleng 1 Oleh Peserta Askeskin. Yogyakarta: Universitas Gadjah mada; 2008.

7. Musril. Utilisasi Pelayanan Kesehatan Oleh Masyarakat Miskin Di Puskesmas Simpang Pandan Kabupaten Tanjung Jabung Timur Propinsi Jambi Yogyakarta: Universitas Gadjah Mada; 2007.

8. Mariana N. Pola Pencarian Pengobatan Pemilik Kartu Jamkesmas Di Kabupaten Tanah Laut Propinsi Kalimantan Selatan. Yogyakarta: Universitas Gadjah Mada; 2009.

9. Park MH, Nguyen TH, Dinh NT, Ngo TD. Government social franchising for reproductive healthcare in Viet Nam. Vietnam2009.


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