Indonesia has created the world’s largest single payer health system. Is it making people healthier?

Edward Broughton

Director, Research and Evaluation, USAID ASSIST Project/URC

Indonesia is the wallflower of international public health – the shy and slightly awkward one at the dance who gets almost no attention. Of course, the life expectancy of Indonesians averages 69, which is a full 13 years lower than its neighbor a few hours south by boat, Australia. It also still has troublingly high levels of tuberculosis and maternal mortality that make it far from the model of health system success.

But in the last five years it has embarked on a massive transformation of health financing by implementing Jaminan Kesehatan Nasional or JKN, the world’s largest single payer health system. It now covers 200 million Indonesians and is planned to cover all by the end of 2019. As a middle-income country, it is committed to providing basic preventive and curative services to all its citizens. As the globe’s fourth largest country by population, with 261 million, this is no small feat.

Major problems remain. To begin, the country had to be cajoled into fulfilling their legal promise to implement JKN by vigorous trade unions, students and NGOs. The system is underfunded, running annual nine-digit deficits (USD), and the quantity and quality of health care available is inadequate so far. But the social security department responsible for building and managing JKN, known as BPJS, is working hard and showing adaptability and determination in its herculean task. The country is trying and, essentially, succeeding to cover all its people with financial protection to access health care. She may not be the belle of the ball, but Indonesia surely deserves its turn on the dancefloor.

The Hospital Accreditation Process Impact Evaluation: Final Report is a monster report of the study on hospital accreditation in Indonesia, which inevitably contains much information of the impact JKN has had on hospitals there. The report is as large and complicated as the country in which it is set. But don’t be put off – it has blessedly brief chapter summaries, so you can just read those and the executive summary and still impress your friends about how you just read a 290-page report.

Download the Hospital Accreditation Process Impact Evaluation: Final Report to learn more.

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