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Health care providers’ perspectives on Indonesian national health insurance (Jaminan Kesehatan Nasional, JKN)

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The Perspectives of Health-Care Providers
on Indonesian National Health Insurance (Jaminan Kesehatan Nasional, JKN)
Susy K. Sebayang, Ralalicia Limato, Desak Ketut Ernawati, Olivia Waworuntu, Grace Monica Halim, Edwin Widodo
Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Indonesia; Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Pharmacology and Therapeutics, Faculty of Medicine, Udayana University, Bali, Indonesia;
Sam Ratulangi University, Manado, Indonesia; ILO Indonesia

Abstract

Indonesia started implementing the national health insurance scheme or Jaminan Kesehatan
Nasional (JKN) in 2014 aimed for universal health coverage by 2019. Concerns about JKN’s
implementation from health-care providers’ perspective has not been much reported. This study
aimed to explore the perspective of health-care providers regarding JKN implementation after two
years of its commencement. In this study, data was collected using quantitative and qualitative
descriptive study. Quantitative data were collected in a one-day JKN workshop held in Jakarta,
Indonesia in November 2015. Prior to the workshop, 50 health care providers including clinicians
and managers from public and private health sectors responded to a questionnaire. Two months
later, a random sample of 33 health care providers who responded to the questionnaire were
contacted and 20 people agreed to take a follow-up phone interview. Descriptive statistics were
used to analyse the data.

The results were eighty-three percent of health care providers expressed that JKN system did
not benefit providers on the grounds of unrealistic costing in INA-CBGs (Indonesia Case-Based
Groups) (50%), suboptimal payment system (27%), complicated management (23%), poor referral
system (3%), insufficient dissemination of JKN system’s information (10%) and providers’
difficulties to acces medicine (7%). The remaining 17% respondents experienced the benefits of
the JKN system in regards to lower cost of medication for the poor (43%) and increased number
of patients utilizing the health services (29%). In the follow-up phone interview of 20 respondents,
85% of the providers reported there was no improvement on the JKN system. The other 15% were
just starting to implement JKN system in their institutions.
This study shows that JKN system is far from ideal for the providers and it needs urgent update
especially on the INA-CBGs and payment system. Although INA-CBGs were developed using
data from more the 100 hospitals, the case-groups variations and sensitivity may need
improvement. Independent monitoring and evaluation from well-established bodies of universal
health coverage, and constant feedbacks from the health care providers and JKN users to
the implementers should be encouraged to improve the current JKN system.

The study was funded by Alumni Grants Scheme No AG 1400075 of Australia Awards Indonesia.

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