As an institution committed to conducting studies and providing policy recommendations on health insurance in Indonesia, in 2024, CHEPS conducted a Feasibility Study: Alternative Implementation of a Cost-Sharing Model for JKN Participants in collaboration with the Deputy for Research and Innovation of BPJS Kesehatan.

 

The sustainability of the Jaminan Kesehatan Nasional (JKN) program and the Dana Jaminan Sosial (DJS) resilience have been a significant concern, mainly due to the deficits experienced in the early implementation of JKN. In recent years, JKN's expenditures have exceeded its revenues, posing risks to the resilience of the DJS and the program's sustainability. Without the right strategic policies, the financing gap in JKN is expected to continue growing. Moreover, policies within the JKN program must also support service quality improvement and the achievement of Universal Health Coverage (UHC).

 

To address these challenges, evidence-based studies are needed to support appropriate policies in the healthcare financing system. One possible intervention is cost containment on the service user side. A mechanism that can be applied is the cost-sharing scheme, aimed at controlling expenses and preventing misuse of healthcare services. This study aims to identify alternative cost-sharing models, their potential impacts, and their feasibility for implementation.

 

The Final Results of the Feasibility Study: Alternative Implementation of a Cost-Sharing Model for JKN Participants were presented in a meeting on Tuesday, January 7, 2025. The meeting was attended by the President Director of BPJS Kesehatan, the Director of Planning and Development of BPJS Kesehatan, the Deputy Director for Research and Innovation Development, the Research Team from the Deputy for Research and Innovation, and the Research Team from CHEPS - LPPKM FKM UI, led by Prof. Budi Hidayat, SKM, MPPM, PhD.

 

The study employed a mixed-methods approach, incorporating a scoping review to identify best practices in cost-sharing implementation across various countries. This was followed by data analysis to explore different cost-sharing models based on type, amount, disease selection, and their impact on the DJS. An Analytical Hierarchy Process (AHP) was conducted to obtain policymakers' perspectives and priority preferences, complemented by Focus Group Discussions (FGD) and In-Depth Interviews (IDI) to enrich qualitative insights.

 

This study highlights how implementing an alternative cost-sharing model can help ensure the sustainability of the JKN program. Simulations indicate that selective cost-sharing implementation can reduce claims and support DJS resilience; however, it is not the sole solution to addressing the deficit. The cost-sharing amount must consider the public's ability to pay and be effective as a behavioral control mechanism. Catastrophic and life-saving services should be excluded to align with the goals and principles of JKN.

 

Implementing this policy is highly sensitive and requires precise regulatory adjustments, the development of information systems and algorithms, interoperability, public outreach and education, stakeholder engagement, and monitoring and evaluation. Cost-sharing is expected to encourage JKN participants to use healthcare services more wisely while ensuring the sustainability of JKN financing.