Indonesia’s National Health Insurance: Service Expansion, Financing Performance, and Sustainability Challenges
DOI:
https://doi.org/10.68191/sena.v1i2.55Keywords:
National Health Insurance, BPJS Kesehatan, Health Financing, Healthcare Utilization, Universal Health CoverageAbstract
Background: Indonesia's National Health Insurance (JKN), administered by BPJS Kesehatan, has expanded to cover more than 279 million people, representing approximately 98% of the population. Despite this achievement, increasing healthcare utilization and financial pressures raise concerns about the program's long-term sustainability.
Research Gap: Existing studies have examined various aspects of JKN implementation; however, an integrated assessment of healthcare facility expansion, service utilization, benefit expenditure, and contribution performance across the program's development remains necessary.
Novelty: This study integrates four operational dimensions of JKN into a descriptive framework, providing a comprehensive overview of service expansion and financing performance during 2014-2025.
Methods: A structured narrative literature synthesis was combined with descriptive analysis of secondary operational data from BPJS Kesehatan. The analysis examined healthcare facilities, service utilization, benefit expenditure, and contribution performance. Fifty-eight publications were included in the narrative synthesis.
Results: By 2025, advanced referral facilities increased by 90.0% to 3,194, with private providers accounting for 65.8%, while primary healthcare facilities increased by 28.9% to 23,770. Service utilization reached 725,338,227, representing a 685.8% increase from 2014. Benefit expenditure accounted for 107.95% of contribution revenue and 108.24% of contribution receipts. During 2020–2025, contribution revenue increased by IDR 36.44 trillion (26.06%), while collection rates improved from 95.77% to 99.73%.
Conclusion: JKN's expansion has been accompanied by substantial financing pressures, highlighting the need to strengthen primary healthcare, improve expenditure management, and regularly assess financing adequacy.
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