Last updated: 05/8/2020
Programme objectives

To improve the access of poor people to health care and to achieve universal health coverage 

References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Country
Geographic area
Previous programme name (if any)
Jamkesmas
Institutions and agencies involved
Start date
2005
References
National Team for the Acceleration of Poverty Reduction. 2015. The Road to National Health Insurance (JKN).
Programme components
Members of the national health insurance are either enrolled in its non-contributory modality (PBI) for the poor, or in its contributory modality (non-PBI) for salaried workers, non-salaried workers and non-employees as well as their family members
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Conditionalities (if any)
 
Contribution type and amount
 
Targeting methods
Proxy Means Test
Targeted areas
Nationwide
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Target groups
The 40 per cent poorest households are targeted for PBI membership
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018. Personal communication.
Eligibility criteria
The poverty status of PBI beneficiaries is determined in accordance with Government Regulation No. 101 of 2013, based on data from the unified database of social assistance recipients maintained by the Poverty Reduction Team (TNP2K)
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Eligibility reassessment (if any)
 
Type of benefits
Health insurance
Amount of benefits
The PBI premium paid to beneficiaries by governments (national and local) is IDR23,000 per person per month (in 2016). The basic benefit package provided based on medical indications covers outpatient and inpatient care at primary level, up to tertiary hospital level. JKN does not cover any procedure outside its regulations: cosmetic procedures; general check-up; prosthetic dental care; alternative therapy which is not scientifically proven; and in vitro fertilization; and infertility programmes including treatment for impotence
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Payment/delivery frequency
Presidential Decree No. 19 of 2016 determines that PBI premiums are paid by central government through the Ministry of Health to BPJS Health from funds of the State budget transferred from the Ministry of Finance
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Benefit delivery mechanism
Health providers are paid based on the services rendered to beneficiaries. Patients are first screened at primary care facilities (puskesmas) and their networks before referral to hospitals if needed. Only in emergency situations are JKN patients allowed to seek treatment directly at a hospital or specialist clinic
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Benefit recipients
Beneficiaries themselves
Minimum and maximum duration of benefits (if any)
 
Coverage
92 million individuals (approximately one-third of the population) were covered under the PBI component in 2016
Programme expenditure
IDR25.5 trillion were allocated to the programme by the central government in 2016
References
IMF. 2017. “Indonesia: Selected Issues.” Country Report No. 17/48. <https://www.imf.org/en/Publications/CR/Issues/2017/02/11/Indonesia-Selected-Issues-44654>. Accessed 23 July 2018.
Monitoring and evaluation mechanisms and frequency
Administrative responsibility for the public health system is divided among the central, provincial and district government levels. A national information system (SIKNAS) is in place, linking to district-level health information systems (SIKDA), however multiple separate reporting systems operate simultaneously
References
WHO. 2017. The Republic of Indonesia Health System Review. India: World Health Organization. <http://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf;jsessionid=E9A5F94883916B632E197BE4998A0BDE?sequence=1>. Accessed 11 May 2018.
Legal Framework
 
MIS
 
Population Group