Achieving Universal Health Coverage by 2019 in Indonesia The Challenges of the Government of Indonesia, Informal Sector Workers and the Local Government

Abstract

Abstract

Achieving Universal Health Coverage by 2019 in Indonesia The Challenges of the Government of Indonesia, Informal Sector Workers and the Local Government

Gemati Ekacita Naskoshi Public Administration Major Graduate School of Public Administration Seoul National University

The purpose of this research is to identify potential challenges encountered by the Government of Indonesia (GOI), informal sector workers, and the local government due to a newly-adopted health care scheme health for all or Universal Health Coverage (UHC). The health care scheme aims to integrate the previously fragmented formal social protection programs, either the programs run by four state-owned enterprises or local governments into a single national health care program. The program is known as National Health Care Insurance or Jaminan Kesehatan Nasional (JKN). There is only one public entity called Social Security Administrative Body or Badan Penyelenggara Jaminan Sosial (BPJS Kesehatan) that has the sole authority on managing the implementation of JKN. JKN is already targeting to provide health care universalism for the entire Indonesian population via Social Health Insurance (SHI) within five years between 2014 and 2019, a very ambitious target considering that Indonesia is the fourth most populous country and the largest archipelago country in the world, with a strong tendency toward decentralization and predominantly inhabited by informal sector workers. Indonesias decentralization policy has helped diversify and further mature the UHC scheme at the regional level prior to implementing JKN. This has become a source of tension between the central and local governments since some local governments have been reluctant to integrate their own version of regional health insurance known as Jaminan Kesehatan Daerah (JAMKESDA) into JKN. JKN adopts SHI as the health care funding mechanism to finance the program. It requires a compulsory membership for all people in Indonesia and a compulsory contribution based on the income level of each individual. This poses challenges for the informal sector workers who make up a predominant percentage of Indonesias total labor force. Such workers are mostly involved in industries such as agriculture, fishery, hunting and forestry. In order to identify the possible challenges, this research has conducted an analysis based on the six facilitating factors by Carrin and James (2005). They argue that the six facilitating factors are key to speeding up the transition toward UHC via SHI. By analyzing the six facilitating factors in the context of Indonesia, it has been found that the government stewardship factor is most critical to solving issues such as the mounting deficit of BPJS Kesehatan which continues to rise each year. Hopefully, this research may be further developed in the future by focusing on the process of JAMKESDAs integration into JKN.

Keywords: Indonesia, Universal Health Coverage, Social Health Insurance, the Government of Indonesia, Informal Sector Workers, Local Government. Student ID: 2014-23731