To enhance public welfare, the Indonesian government has implemented various policies, one of which is the National Health Insurance (JKN) program as a social protection initiative. The Premium Assistance Beneficiary (PBI) scheme under JKN ensures that underprivileged communities can access essential healthcare services.
Despite the expanded coverage of the PBI JKN program, beneficiaries are still burdened by out-of-pocket (OOP) expenses. These OOP costs include both direct medical and non-medical expenses. Direct medical expenses cover registration fees, medication, treatments, and laboratory tests, while direct non-medical expenses include transportation and other informal costs.
Studies by SMERU and Bappenas in 2021 have shown that JKN participation can ease the OOP burden for low-income communities. However, the findings also reveal that these groups are still burdened by non-medical OOP costs, which hinder their access to healthcare services. This indicates that the PBI JKN program has not been fully effective. Building on this context, the central government needs to conduct a deeper assessment of the impact of the PBI JKN program in achieving quality, inclusive, and sustainable social security.
The government is focused on finding ways to reduce the OOP burden and ensure that all PBI JKN beneficiaries have optimal access to healthcare. Evaluation and periodic strategy improvements are essential to ensure that all layers of society can access healthcare without facing financial hardship.
Under the strategic guidance and full support of the Directorate of Population and Social Security, Ministry of National Development Planning/National Development Planning Agency (Bappenas), SMERU undertakes a study to support the government in analyzing the impact of premium assistance in JKN. This study provides a deeper understanding of how JKN supports beneficiaries receiving premium assistance in the sample locations in accessing healthcare facilities and services, including catastrophic care, while examining the influencing factors. The insights gained are expected to inform strategic recommendations for the government to alleviate the OOP burden on PBI JKN beneficiaries, contributing to the achievement of quality, inclusive, and sustainable social security.
The objectives of this study are as follows:
- To explore the influence of JKN on the quality of health and healthcare services, including catastrophic healthcare services, received by beneficiaries receiving premium assistance
- To identify various factors influencing the utilization of healthcare facilities, including catastrophic healthcare services, by PBI JKN beneficiaries
This study employs a qualitative approach through in-depth interviews, observations, and secondary data collection. In-depth interviews involve various stakeholders, service providers, and PBI JKN beneficiaries at the kabupaten to village levels. Beneficiaries in this study include those subsidized by the national government and those subsidized by sub-national governments.
The study encompasses the following scope:
- Exploring qualitative aspects related to the issues and conditions faced by PBI JKN beneficiaries in utilizing healthcare services
- Identifying the reasons why PBI JKN beneficiaries still incur OOP expenses to access healthcare services and assessing the extent to which these expenses increase their financial burden
- Measuring the extent of access that PBI JKN beneficiaries have to healthcare services and catastrophic disease care
- Evaluating the effectiveness of JKN in preventing OOP cost burdens or providing financial protection against catastrophic illnesses for PBI JKN beneficiaries
- Formulating strategies to reduce the OOP burden on PBI JKN beneficiaries
