No, Sick No Pay

“Through national health insurance, all poor people of Indonesia could access free health care at the Health Center and Hospital” said President of Indonesia at Bogor Palace.

National health insurance, known also as national health care is one of the tools that could reduce financial barriers to access health care. The monthly premium is used as a finance source to pay health care benefits, thus actuaries need to estimate the risk and health expenses. Germany is one of the oldest country using social health insurance system since 1883. While Indonesia was just implementing it by the January 1st, 2014 called as Jaminan Kesehatan Nasional (JKN).

Currently, JKN is covering about 50% of the Indonesia population including poor people and expected to cover all people in the next 5 years. In addition, foreigner who is living in Indonesia for more than 6 months also could be covered as long as they pay the premium. There are two main types of membership under this new scheme. Those are poor people scheme which premium is fully paid by the government with a third class of hospitalization accommodation benefit, and non-poor people scheme who can choose the different class of hospitalization accommodation benefit with different rate of premiums.

Both schemes have a comprehensive health benefit including promotion, prevention, curative, and rehabilitation at primary and secondary care level, both public and private. In addition, there is also regulation of no co-sharing allowed. Meaning, patients especially poor one are protected from financial catastrophic due to treatment.

It sounds very good policy and promising. However, health facilities are limited compared to the number of patients visited and admitted. Long queue and lack of time for health workers for giving an adequate services are the main concerns which could lead to negative impacts of quality services. Furthermore, there is potential tendency of people buy insurance only when they are sure will get benefit from it shortly. Means, that sicker people are the one likely to pay the premium, and sustainable financing become a big question in the future.

In summary, protecting people from financial hardship by health insurance is one of the policy options to achieve universal health coverage which has its advantages and disadvantages. Innovative policy to overcome the challenges are needed.


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