Jakarta, The PRAKARSA – In commemoration of International Universal Health Coverage Day on December 12, The PRAKARSA released preliminary research findings on the achievement of Universal Health Coverage (UHC) in Indonesia. The launch of these preliminary research findings was carried out during an online public discussion agenda entitled "Achievements, Challenges, and Opportunities for UHC Implementation in the National Health System." This agenda was attended by Ali Ghufron Mukti (President Director of BPJS Kesehatan); Hasbullah Thabrany (Public health expert), Gamal Albinsaid (Doctor and Member of Commission IX of the Indonesian House of Representatives, Prosperous Justice Party Faction); Intan Novia (Head of the Health Expenditure Analysis Working Team, Health Financing Center, Ministry of Health of the Republic of Indonesia); and Feby Oldfisra (National Professional Officer of Health Financing, World Health Organization (WHO) Indonesia).
This research on UHC achievement in Indonesia is a continuation of similar research conducted by The PRAKARSA in 2020. This research focused on analyzing three things: national achievement of the UHC index, out-of-pocket (OOP) spending, and financial protection from impoverishment due to catastrophic health expenditures. Researchers at The PRAKARSA, Bintang Aulia Lutfi, on this occasion explained that even though the national UHC index score increased by 3 (three) points from 60 (2020) to 63, this achievement is still below the WHO score of 67. "The increase in the UHC score was due to improved achievements in several dimensions, including Communicable Diseases (score 75), and Non-Communicable Diseases (score 68). However, a drastic decline occurred in the Maternal and Child Health (MCH) dimension, especially in the immunization indicator." In addition, Bintang also highlighted the problem of service gaps and inadequate financial protection, especially for households in the lowest expenditure quintile. "Around 12,85 million Indonesians experience catastrophic health expenditures at the 10% threshold and millions of people are still at risk of falling into poverty due to out-of-pocket (OOP) costs for health, with the highest incidence occurring in the Riau Islands, DI Yogyakarta, and several provinces in Sumatra," said Bintang.
In his remarks, the President Director of BPJS Kesehatan, Ali Ghufron Mukti, stated that although National Health Insurance (JKN) coverage has reached 98% of the Indonesian population, the health system must be viewed not only from the demand side but also from the supply side. This encompasses access, infrastructure, and other services. Therefore, congruence is needed between stakeholders, starting from the central government, regional governments, and the legislature. He also emphasized that the health system approach must change, "not only focusing on curative care, but also promotive and preventive care."
The Executive Director PRAKARSAIn her remarks, Victoria Fanggidae emphasized the need for needs-based healthcare and the elimination of discriminatory practices based on economic background. She also emphasized that there is no single solution or policymaker to improve the healthcare system, and that collaboration, communication, and a long-term vision are needed if Indonesia is to become a developed nation in terms of the quality of its healthcare services.
Head of the Health Expenditure Analysis Working Team, Health Financing Center, Ministry of Health of the Republic of Indonesia, Intan Novia Fatma Nanda, expressed her appreciation for the research and findings presented by PRAKARSAThis study not only examined the participation aspect but also the quality of services and financial protection. He stated that the findings PRAKARSA This is in line with the WHO-World Bank report which shows that Indonesia is moving towards the global trend towards Universal Health Coverage. He suggested, "The analysis in this research will be more comprehensive if it also links the results of the National Health Account, because the integration of the financing perspective through the NHA can help explain the relationship between health spending patterns, funding priorities, and service achievements in the field." Public health expert, who is also one of the architects of the National Health Insurance (JKN) system, Hasbullah Thabrany, appreciated the results of the initial research findings conducted by PRAKARSAHowever, Hasbullah highlighted the methodology used in measuring the UHC version. PRAKARSA, especially regarding the supplementary data used, and the explanation regarding catastrophic and Out-of-Pocket expenditures. "Indeed, the results of the UHC measurement by PRAKARSA similar to WHO although slightly lower but not in the level of accuracy in measuring but in the mapping pattern of which regions are still lacking and which are more so that each region can catch up”. Hasbullah also added “it would be better if out of pocket was conducted through a special survey by the government so that the accuracy of the figures would be more representative”. Hasbullah also encouraged the establishment of a Health Funding Information System (SIPK) in accordance with the mandate of Law No. 17 of 2023 concerning Health to find out factual data regarding health expenditure.
Member of Commission IX of the Indonesian House of Representatives, Gamal Albinsaid, also appreciated the research conducted by The PRAKARSA He hopes the research can inform policymaking. Gamal also highlighted structural issues within Indonesia's healthcare system, noting that, "despite the National Health Insurance (JKN) coverage reaching 98 percent of the population, many JKN participants remain inactive, and infrastructure in remote areas remains severely underdeveloped and inadequate."
Gamal explained that "people outside Java, if I say directly, in practice provide subsidies to Javanese people because they pay the same BPJS premiums but receive unequal health facilities" and emphasized that "this needs to be a concern for the Ministry of Health in accelerating the improvement of health facilities in underdeveloped areas." Gamal also recommended the creation of evidence-based multi-stakeholder collaboration to overcome structural barriers to both JKN coverage and the overall achievement of UHC. Finally, the National Professional Officer of Health Financing, World Health Organization (WHO) Indonesia, Feby Oldfisra, also appreciated the research results released by The PRAKARSAFeby, representing WHO, stated that the measurement of UHC achievement in Indonesia has shown improvement for both UHC indicators, namely service coverage and financial difficulties in accessing health services. However, Indonesia's position is still behind peer countries such as Vietnam, Thailand, and Malaysia. In addition, Feby also explained the percentage of Out-of-Pocket (OOP) expenditure in Indonesia, which, although the figure has improved to 26,6 percent with the latest method issued by WHO, the improvement trend is sloping from year to year. The latest method also shows that the lowest or poorest expenditure group is the one who experiences the most severe financial difficulties in accessing health services.
Based on initial research findings and input from various parties, The PRAKARSA recommends several policy options, including establishing preventive services as an obligation of the Regional and National Budgets, developing Health Social Assistance to reduce the non-medical burden on households, establishing a Regional Health Fund for near-poor groups, establishing the UHC index as a mandatory performance indicator in evaluating the fulfillment of Minimum Service Standards (SPM) for health, including in the Health Sector Master Plan (RIBK). PRAKARSA will soon publish the complete research results in the near future.