Indonesia has a national health insurance program called JKN that provides coverage to all Indonesian citizens. JKN is administered by BPJS Health and uses a structured referral system where patients first visit primary healthcare clinics (Puskesmas) and are referred to larger hospitals if needed. There are three classes of coverage under JKN with different monthly premiums depending on employment status. The system faces challenges in ensuring adequate equipment and facilities at primary care clinics to assess and treat patients before referral.

1. Healthcare System
in Indonesia
Muhammad. Z. Haris, MD

3. East Asia & Pacific (developing only)
Income level Lower middle income
GDP (current US$)
$868.3 billion 2013
Population, total
249.9 million 2013

4. BPJS Health - JKN
(National Health Insurance)
• Govt. Institution
• Regulate the JKN (NHI)
• Since Jan 1, 2014
• For every Indonesia citizen
• Foreigner
(6 months worked in Indonesia)
• “Structured Referral”

5. JKN Participants
• Civil worker, military, police, government officials
• Recipient
• Poor people
• Non-recipient
• Employees, entrepreneurs, service providers, etc.

6. JKN Premium
• Civil worker, military, police, government officials  5% of monthly salary
• Recipient  Free (covered by government)
• Non-recipient
• 1st
class  $ 6.0/person/month
• 2nd
class  $ 4.5/person/month
• 3rd
class  $ 2.5/person/month

7. Structured Referral
Treatment Ladder
(Unless emergency)

8. Primary Healthcare (Puskesmas)
Puskesmas Kelurahan Puskesmas Kecamatan

10. Primary Healthcare (Puskesmas)
Puskesmas Kelurahan Puskesmas Kecamatan

12. Structured Referral
Treatment Ladder
(Unless emergency)

13. Primary Healthcare (Puskesmas)
Check-up & Consultation
Medical examination &
treatment

14. Blood
transfusion
Inpatient Simple lab diagnostic
examination

15. Referral to higher healthcare level
How come they
expect me to
assess all patients
with those
equipments ?
BPJS
Health
Hospita
l
Partnered
with
PUSKESMASPUSKESMAS

16. Secondary Healthcare (Hospital)
Consultation & examination conducted
by specialist
Medical treatment
and intervention
conducted by
specialist

17. Blood
Transfusion
Prodia
Laboratory
Better lab
diagnostic
facility
Inpatient is now
covered in non-intensive
and intensive care unit

18. Excemptions from Coverage
ITAL
We have no
agreement
with Govt!
Hospital
Like I want
to follow
that stupid
‘Ladder’

19. Abroad
Healthcare
facility

20. “Alternative”
medicine
Drugs / alcohol
addiction
Cosmetic/beauty
treatment

21. Posyandu (Integrated Health Post)
• A community-based healthcare
• A monthly clinic for children under five and pregnant women
• Attended by mothers, children, community volunteers, staff from the health centers,
and/or family planning fieldworkers
• Providing : vaccinations, vitamins & nutritional supplements (oral or injection),
prenatal & postnatal exams, immunization, vitamin & nutritional screening, and oral
contraceptives
• >260,000 Posyandu posts nationwide

23. Reference
 BPJS Kesehatan. (2014, May 8). Iuran. Retrieved from http://bpjs-
kesehatan.go.id/bpjs/index.php/pages/detail/2014/13
 Dinas Kesehatan Kota Kediri. (2014, May 22). Data Umum
puskesmas kota wilayah selatan. Retrieved from
http://dinkes.kedirikota.go.id/?p=106
 Dinas Komunikasi. (October 2014).Puskesmas kecamatan Menteng.
Retrieved from
http://www.jakarta.go.id/web/encyclopedia/detail/3936/Puskesma
s-Kecamatan-Menteng
 Jaques, H. (2015, January 12). Still in its infancy, Indonesia's national
health service makes an impact. Retrieved from
http://asia.nikkei.com/Business/Trends/Still-in-its-infancy-Indonesia-s-
national-health-service-makes-an-impact

24. Reference
 Pusat Komunikasi Publik. (2014, August 18). Menkes ungkap
berbagai tantangan penyelenggaraan JKN di fasilitas kesehatan.
Retrieved from http://www.jkn.kemkes.go.id/detailberita.php?id=76
 Pusat Komunikasi Publik. (2014, October 15). Senyum keluarga
posyandu untuk selamatkan ibu. Retrieved from
http://www.depkes.go.id/article/view/201410270005/senyum-
keluarga-posyandu-untuk-selamatkan-ibu.html
 Puskesmas rujukan RSUD. (2014, June 12). Retrieved from
http://www.tribunnews.com/images/regional/view/1202072/puskes
mas-rujukan-rsud#.VQCdRJU5BwE
 RAND Corporation. (n.d. ). Health Facilities: Photos from pilot tests of
the survey instrument. Retrieved from
http://www.rand.org/labor/FLS/IFLS/photos/facpix.html