Insurance Utilities in Indonesia: A Study for Future Opportunities
DOI:
https://doi.org/10.51601/ijhp.v5i2.370Abstract
This study analyzes Indonesia's path toward universal health coverage (UHC), which has been marked by the introduction of targeted schemes such as Askeskin and Jamkesmas, culminating in the comprehensive National Health Insurance (JKN) program. This literature review systematically synthesizes peer-reviewed empirical studies published between 2005 and March 2025, examining the impact of government-managed health insurance on healthcare utilization, financial protection, and equity across different population groups. The study conducted a structured narrative synthesis of studies retrieved from PubMed, Scopus, Web of Science, and Google Scholar, focusing on inpatient and outpatient services, maternal and dental care, and out-of-pocket expenditures. The findings indicate that insured individuals consistently demonstrate higher utilization rates and significant reductions in out-of-pocket spending, with notable benefits in maternal health and primary care in rural areas; however, geographic and socioeconomic disparities persist, particularly among the urban poor and remote communities. Secondary analysis revealed moral hazard effects and shifting private market dynamics, highlighting the need for cost-sharing mechanisms and regulatory oversight. Propose policy strategies to expand enrollment, adjust premium subsidies, integrate fragmented schemes, strengthen the community health center (Puskesmas) infrastructure, and enhance preventive care and health literacy. An integrated approach aligning financial, clinical, and regulatory reforms is essential to optimize equity, efficiency, and sustainability in Indonesia’s UHC journey.
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V. Maylia Ardini and E. Puspitaloka Mahadewi, “The Development of Health Insurance and Services in Indonesia,” International Journal of Health and Pharmaceutical (IJHP), vol. 2, no. 3, pp. 440–446, May 2022, doi: 10.51601/ijhp.v2i3.65.
Q. Cheng et al., “Determinants of healthcare utilization under the Indonesian national health insurance system – a cross-sectional study,” BMC Health Serv Res, vol. 25, no. 1, p. 48, Jan. 2025, doi: 10.1186/s12913-024-11951-8.
M. E. Arviana, F. Hafidz, and H. Setiyaningsih, “The relationship between health insurance ownership and health service utilization, out-of-pocket expenses, and catastrophic health expenditure in the Special Region of Yogyakarta in 2023,” BIO Web Conf, vol. 132, p. 04002, Oct. 2024, doi: 10.1051/bioconf/202413204002.
W. Wang, G. Temsah, and L. Mallick, “The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda,” Health Policy Plan, p. czw135, Oct. 2016, doi: 10.1093/heapol/czw135.
R. D. Wulandari, A. D. Laksono, R. Mubasyiroh, R. Rachmalina, M. Ipa, and N. Rohmah, “Hospital utilization among urban poor in Indonesia in 2018: is government-run insurance effective?,” BMC Public Health, vol. 23, no. 1, p. 92, Jan. 2023, doi: 10.1186/s12889-023-15017-y.
A. Chrisnahutama, “Pengaruh asuransi kesehatan nasional terhadap pengeluaran kesehatan pada penduduk lanjut usia di Indonesia,” Journal of Economics Research and Policy Studies, vol. 3, no. 2, pp. 116–132, Aug. 2023, doi: 10.53088/jerps.v3i2.771.
N. Rosnani, R. Hastuti, and E. Puspitaloka Mahadewi, “Analysis Of Demand For Health Insurance Business During The Indonesian Covid Pandemic,” International Journal of Health and Pharmaceutical (IJHP), vol. 2, no. 3, 2022, doi: 10.51601/ijhp.v2i3.106.
G. Ayu, H. Fermansyah, and E. Puspitaloka Mahadewi, “A Study of Managed Care Health System During Pandemic,” International Journal of Science, Technology & Management, vol. 4, no. 4, pp. 802–808, Jul. 2023, doi: 10.46729/ijstm.v4i4.846.
Nabila Erinaputri, R. Listiani, Faza Duta Pramudyawardani, and Novita Dwi Istanti, “Peran Puskesmas Untuk Mencapai Universal Health Coverage di Indonesia: Literature Review,” Jurnal Medika Nusantara, vol. 1, no. 2, pp. 190–199, May 2023, doi: 10.59680/medika.v1i2.310.
B. Y. Gitaharie, R. Nasrudin, A. P. A. Bonita, L. A. M. Putri, M. A. Rohman, and D. Handayani, “Is there an ex-ante moral hazard on Indonesia’s health insurance? An impact analysis on household waste management behavior,” PLoS One, vol. 17, no. 12, p. e0276521, Dec. 2022, doi: 10.1371/journal.pone.0276521.
“Perceived need and utilization of dental health care services in Indonesia: A secondary analysis using the national socioeconomic data,” Makara Journal of Health Research, Aug. 2020, doi: 10.7454/msk.v24i2.1218.
A. Risdiyanti, H. Paramu, and S. Sunarto, “HEALTH FINANCING ANALYSIS OF MINIMUM SERVICE STANDARDS IN THE HEALTH SECTOR,” Jurnal Administrasi Kesehatan Indonesia, vol. 12, no. 1, pp. 62–73, Jun. 2024, doi: 10.20473/jaki.v12i1.2024.62-73.
R. D. Wulandari, A. D. Laksono, N. Rohmah, and H. Ashar, “Regional differences in primary healthcare utilization in Java Region—Indonesia,” PLoS One, vol. 18, no. 3, p. e0283709, Mar. 2023, doi: 10.1371/journal.pone.0283709.
A. D. Laksono, R. D. Wulandari, N. Rohmah, R. Rukmini, and T. Tumaji, “Regional disparities in hospital utilisation in Indonesia: a cross-sectional analysis data from the 2018 Indonesian Basic Health Survey,” BMJ Open, vol. 13, no. 1, p. e064532, Jan. 2023, doi: 10.1136/bmjopen-2022-064532.
N. M. Fitrianingrum, F. Z. Kamilah, A. Larasanti, M. A. Saputra, A. Espressivo, and O. Herlinda, “Supply-side Readiness of Primary Health Care for COVID-19 Pandemic Response in Indonesia: A Survey in 34 Provinces,” Nov. 20, 2024. doi: 10.21203/rs.3.rs-5272753/v1.
N. A. Kapologwe et al., “Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania,” BMC Health Serv Res, vol. 20, no. 1, p. 218, Dec. 2020, doi: 10.1186/s12913-020-5057-2.
E. P. , Mahadewi, METODE RISET BISNIS (Business Research Methods). PT. Literasi Nusantara Abadi Grup.
A. Jenis, D. Penelitian, and J. Penelitian, “BAB III METODE PENELITIAN A. Jenis dan Desain Penelitian 1. Jenis Penelitian,” pp. 52–77, 2007.
Natasya Nazla Prasetyo, Keren Stelin Maliangkay, Putri Andini Novianti, Risma Pertiwi, and Sarah Rania Annisa, “Health Accessibility In Rural Areas For The Elderly In Indonesia,” Jurnal Rumpun Ilmu Kesehatan, vol. 3, no. 2, pp. 15–26, May 2023, doi: 10.55606/jrik.v3i2.1716.
Z. Shi, P. He, D. Zhu, F. Lu, and Q. Meng, “Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China,” BMC Health Serv Res, vol. 22, no. 1, p. 1226, Oct. 2022, doi: 10.1186/s12913-022-08602-1.
L. Nguyen and A. C. Worthington, “Moral hazard in Australian private health insurance: the case of dental care services and extras cover,” Geneva Pap Risk Insur Issues Pract, vol. 48, no. 1, pp. 157–176, Jan. 2023, doi: 10.1057/s41288-021-00245-3.
C. Li, L. Xu, H. Wang, X. Wang, and C. Tang, “The influence of integration of health-insurance schemes on catastrophic health expenditure in China: a cohort study,” The Lancet, vol. 396, p. S8, Nov. 2020, doi: 10.1016/S0140-6736(20)32428-4.
W. Chen, Q. Zhang, A. M. N. Renzaho, F. Zhou, H. Zhang, and L. Ling, “Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study,” BMJ Glob Health, vol. 2, no. 4, p. e000477, Oct. 2017, doi: 10.1136/bmjgh-2017-000477.
A. R. Hasan, A. Bachtiar, and C. Candi, “The Potential of Private Health Insurance Ownership Based on the 2018-2020 National Socioeconomic Survey Data,” Kesmas: Jurnal Kesehatan Masyarakat Nasional, vol. 17, no. 4, p. 287, Nov. 2022, doi: 10.21109/kesmas.v17i4.6214.
A. D. Laksono, R. D. Wulandari, D. E. Efendi, T. Tumaji, and Z. K. Nantabah, “Role of Socioeconomic Status in National Health Insurance Ownership in Indonesia’s Rural Areas,” J Res Health Sci, vol. 24, no. 1, p. e00608, Mar. 2024, doi: 10.34172/jrhs.2024.143.
A. D. Laksono, R. D. Wulandari, and R. Matahari, “The determinant of health insurance ownership among pregnant women in Indonesia,” BMC Public Health, vol. 21, no. 1, p. 1538, Dec. 2021, doi: 10.1186/s12889-021-11577-z.
J. Boone, “Basic versus Supplementary Health Insurance: Moral Hazard and Adverse Selection,” SSRN Electronic Journal, 2014, doi: 10.2139/ssrn.2505955.
X. Liu, D. Nestic, and T. Vukina, “ESTIMATING ADVERSE SELECTION AND MORAL HAZARD EFFECTS WITH HOSPITAL INVOICES DATA IN A GOVERNMENT‐CONTROLLED HEALTHCARE SYSTEM,” Health Econ, vol. 21, no. 8, pp. 883–901, Aug. 2012, doi: 10.1002/hec.1756.
P. Zweifel and W. G. Manning, “Chapter 8 Moral hazard and consumer incentives in health care,” 2000, pp. 409–459. doi: 10.1016/S1574-0064(00)80167-5.
H. Yuan, J. Han, and R. Luo, “The moral dilemma of healthcare service utilization: a perspective from the consolidation of urban and rural resident health insurance policy in China,” Health Econ Rev, vol. 15, no. 1, p. 10, Feb. 2025, doi: 10.1186/s13561-025-00591-1.
Z. Li, Y. Chen, and J. Ding, “Impact of health insurance equity on poverty vulnerability: evidence from urban–rural health insurance integration in rural China,” Front Public Health, vol. 11, Nov. 2023, doi: 10.3389/fpubh.2023.1328265.
T. Yamada, C.-C. Chen, T. Yamada, H. Noguchi, and M. Miller, “Private Health Insurance and Hospitalization Under Japanese National Health Insurance,” The Open Economics Journal, vol. 2, no. 1, pp. 61–70, Sep. 2009, doi: 10.2174/1874919400902010061.
Y. Tang, R. Fu, and H. Noguchi, “Impact of medical insurance integration on reducing urban-rural health disparity: Evidence from China,” Soc Sci Med, vol. 357, p. 117163, Sep. 2024, doi: 10.1016/j.socscimed.2024.117163.
N. Maulana, P. Soewondo, N. Adani, P. Limasalle, and A. Pattnaik, “How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia,” PLOS Global Public Health, vol. 2, no. 7, p. e0000203, Jul. 2022, doi: 10.1371/journal.pgph.0000203.
S. Putri Agustin, S. Tunom, and E. Puspitaloka Mahadewi, “Factors Analysis Influencing on Demand for Private Health Insurance in Indonesia After Pandemic,” International Journal of Science, Technology & Management, vol. 4, no. 4, pp. 963–971, Jul. 2023, doi: 10.46729/ijstm.v4i4.898.
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Copyright (c) 2025 Ingrid Green Nego, Dika Oktaviani Yustedjo, Hotmada Parlindungan, Erlina Puspitaloka Mahadewi
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