BPJS Kesehatan's strategy to protect 275 million Indonesians with health insurance

By Mochamad Azhar

Ghufron Mukti, President Director of BPJS Kesehatan, told GovInsider how the national healthcare and social security agency is working to ensure affordable healthcare through digitalisation and inclusive health financing.

President Director of BPJS Kesehatan, Ghufron Mukti (right), explains the National Health Insurance (JKN) programme to foreign delegates. Digitalisation and inclusive financing have been identified as key factors to realise affordable and accessible health services for the public. Image: BPJS Kesehatan.

The Indonesian Government is one step closer to achieving Universal Health Coverage (UHC) and fulfilling the basic right of all citizens to access quality healthcare anywhere, anytime, and at an affordable cost.

In Indonesia, membership in the National Health Insurance (JKN) is required for citizens to access health facilities. Each participant must pay monthly contributions that vary depending on the health facility class they wish to have access to. Citizens pay between USD2 and USD9.5 a month for active membership.

For those who have full-time employment, contributions are borne by both participants and their employers. Meanwhile participants who are unemployed or are freelancers are solely responsible for paying their dues.

"As of 1 March 2024, the number of JKN participants has reached 268.74 million people or 96.28% of the total population. We are optimistic that the UHC target will be achieved this year," Ghufron Mukti, President Director of BPJS Kesehatan, told GovInsider.

Ghufron shared about the innovations and collaborative efforts made by BPJS Kesehatan, which is responsible for the world’s largest government-based national health insurance system, to ensure that the entire population will be covered by health insurance.

Digitalisation of the health insurance system

According to Ghufron, digital technology has proven effective in increasing membership rates, especially through the Mobile JKN platform, which makes it easier for participants to register, pay contributions, and obtain the necessary health services.

"Digitalisation and the use of healthcare technology have had a significant impact on service delivery, competitiveness, ease of access, and public satisfaction."

In 2020, the number of JKN participants was 220.2 million and this has increased to 268.7 million four years later, with 18 million people (about the population of New York) accessing services through the Mobile JKN app.

GovInsider previously reported on how the app also offers telemedicine services. This service was trialled in 2022 to support those who live far from health facilities.

Currently, the Mobile JKN app has been equipped with an online queue feature to reduce time spent waiting at health facilities. Mobile JKN also provides health history monitoring services to detect the risk of chronic diseases through the i-Care JKN feature.

"In the future, this application will continue to be developed with data on doctor availability and bed availability at government hospitals," said Ghufron.

Keeping membership status active

To achieve the goal of universal health coverage, Ghufron and BPJS Kesehatan aim to ensure that all JKN participants are able to keep up with their contributions, with the aid of subsidies if necessary. Image: BPJS Kesehatan.

The main challenge in achieving UHC, according to Ghufron, is how to ensure that all JKN participants have the financial means to maintain active memberships. Based on BPJS Kesehatan data, 53.7 million people – 20 per cent of all participants – are inactive.

These may include non-wage-earning participants or informal workers who have not contributed their membership dues regularly.

Ghufron urged independent participants to pay their dues regularly to avoid administrative issues when registering for health services at hospitals.

"Solutions offered include working with banks to auto-debit participants' accounts and ensure that their membership remains active. Currently, 8.2 million participants have paid their dues through auto-debit," said Ghufron.

In addition, BPJS Kesehatan has also collaborated with 960 digital payment service providers, ranging from digital wallet services and e-commerce applications, to payment points at retail stores and others. These services are convenient for those who do not have bank accounts or live in remote areas.

BPJS Kesehatan also offers a Phased Payment Plan (REHAB) programme through the Mobile JKN application or customer service. This REHAB programme provides relief and convenience for non-wage earner segment participants to make payments in instalments.

Ensuring inclusive health insurance

According to Ghufron, inclusive health insurance is a key goal for achieving UHC. This would ensure that no one is left out of the health insurance system.

Within the non-wage-earning segment, there are poor workers who have irregular incomes or do not work, and thus have limited access to health facilities. This group is not covered by the Government or employers, and cannot afford to pay contributions given their financial insecurity and being barely able to fulfil their daily needs.

"The Government subsidises this group by enrolling them in the JKN class III programme. [Enrolling them in the most affordable tier ensures that] they are not overburdened by monthly payments and can still access health services," said Ghufron.

Other solutions include subsidies provided to the poor in collaboration with the central and local governments, and by seeking donations from philanthropic organisations and business entities.

This article was originally published in Bahasa Indonesia.

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