Health Insurance Model In The Perspective Of Health Economics: Transformation, Regulation, And Implementation In Indonesia
DOI:
https://doi.org/10.51601/ijhp.v5i3.421Abstract
Health insurance is an important component of the health financing system that aims to ensure equitable and sustainable access to health services. From a health economics perspective, the insurance system is able to mitigate the financial risk of illness while managing the efficiency and distribution of financing collectively. This study examines the development of health insurance models in Indonesia, ranging from traditional, modern, to managed care models, and analyses the challenges and implementation strategies of the National Health Insurance (JKN) programme by BPJS Kesehatan. A qualitative approach based on literature study was used with data sources from scientific journals, national regulations, BPJS Kesehatan reports, and public policy documents.The results show that the traditional model tends to be inefficient because it is prone to overutilisation and fraud. Modern models and managed care provide solutions through quality and cost control. However, the implementation of JKN in Indonesia still faces various challenges, such as delays in claim payments, moral hazard, and financing imbalances. One strategy for system sustainability is through the optimisation of participant fund assets, which can be productively invested to support promotive services, infrastructure, and strengthening the healthcare system. With transparent governance, the results of this asset optimisation can be returned for the benefit of the wider community. This study is expected to be a scientific contribution in supporting health financing policy reforms that are inclusive, efficient, and sustainable.
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References
World Health Organization. Health financing for universal health coverage. Geneva: WHO; 2020.
BPJS Kesehatan. Laporan Tahunan BPJS Kesehatan 2023. Jakarta: BPJS Kesehatan; 2024.
Dewi FST, Kristiansen S. Challenges and opportunities in Indonesia’s national health insurance system (JKN): a systematic review. Global Health Action. 2021;14(1):1883127.
Taneja G, Sarin E, Atun R. Health insurance models and evolving roles of private sector: a global review. Health Policy Plan. 2021;36(5):728–735.
Zhu J, Zhang Y. The transition of health insurance models in developing countries: from reimbursement to managed care. BMC Health Serv Res. 2020;20(1):1–9.
Undang-Undang Republik Indonesia Nomor 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional.
Peraturan Presiden Republik Indonesia Nomor 82 Tahun 2018 tentang Jaminan Kesehatan.
Peraturan Menteri Kesehatan Republik Indonesia Nomor 21 Tahun 2020 tentang Rencana Aksi Nasional Pengendalian Penyakit Tidak Menular.
Kementerian Kesehatan Republik Indonesia. Strategi Nasional Reformasi Sistem Pembiayaan Kesehatan. Jakarta: Kemenkes RI; 2023.
Otoritas Jasa Keuangan. POJK No. 69/POJK.05/2016 tentang Penyelenggaraan Usaha Asuransi.
Susanto, B. (2021). Konsep legalitas dan tanggung jawab hukum dalam penyelesaian sengketa asuransi. Jurnal Ilmu Hukum Indonesia, 11(3), 201–216.
Al-Dhubaib, B. E. (2021). Legal principles in insurance contracts: A comparative analysis. Journal of Risk and Insurance Research, 58(2), 145–160. https://doi.org/10.1016/j.jrire.2021.03.004
Kartasapoetra, G. (2021). Aspek hukum dalam asuransi modern. Jakarta: Rineka Cipta.
Nugroho, R. (2022). Kebijakan publik dan transparansi dalam sektor jasa keuangan. Yogyakarta: Gadjah Mada University Press.
Tjiptono, F. (2022). Manajemen risiko dan asuransi: Perspektif bisnis dan hukum. Malang: UB Press.
Sugiyono. (2020). Metode Penelitian Kualitatif, Kuantitatif, dan R&D. Bandung: Alfabeta.
Darmodiharjo, D., & Satrio, A. (2022). Hukum dan perubahan sosial. Jakarta: Prenadamedia Group.
Baldwin, R., & Cave, M. (2022). Understanding Regulation: Theory, Strategy, and Practice. Oxford University Press.
POJK No. 14/POJK.05/2021 tentang Penerapan Manajemen Risiko bagi Perusahaan Asuransi.
POJK No. 13/POJK.05/2022 tentang Penyelenggaraan Layanan Asuransi Berbasis Teknologi Informasi.
Putri, R. P., & Santoso, B. (2022). Analisis Prinsip-Prinsip Hukum dalam Asuransi Kesehatan. Jurnal Hukum dan Kesehatan, 10(2), 123–134.
Widjaja, G. (2023). Asuransi dan hukum bisnis di Indonesia. Jakarta: RajaGrafindo Persada.
Hadjon, P. M., & Tatiek, S. (2023). Pengantar hukum administrasi Indonesia. Surabaya: Lembaga Penerbit Fakultas Hukum Universitas Airlangga.
Kurniawan, A. (2023). Regulasi dan implementasi prinsip utmost good faith dalam asuransi jiwa. Jurnal Hukum dan Pembangunan, 53(1), 89–104. https://doi.org/10.21143/jhp.vol53.no1.3781
Nugroho, A. Y. (2023). Risiko dalam Asuransi: Klasifikasi dan Penanganan. Yogyakarta: Deepublish.
Kartini, D. (2021). Prinsip Subrogasi dalam Asuransi Modern. Jakarta: Prenadamedia Group.
Vaughan, E. J., & Vaughan, T. M. (2014). Fundamentals of Risk and Insurance. Wiley.
OECD. (2021). Understanding the Digital Transformation in Insurance. OECD Publishing.
Asosiasi Rumah Sakit Swasta Indonesia. (2024). Laporan Tahunan ARSSI 2023: Tantangan dan Harapan Pelayanan Rumah Sakit Swasta dalam Era JKN. Jakarta: ARSSI.
BPJS Watch. (2024). Catatan Kritis Sistem Jaminan Kesehatan Nasional Tahun 2023. Jakarta: BPJS Watch.
Kementerian Kesehatan Republik Indonesia. (2024). Evaluasi Sistem Pembiayaan Kesehatan Indonesia Tahun 2023. Jakarta: Pusat Pembiayaan dan Jaminan Kesehatan.
Nuraini, S., & Prasetyo, Y. (2023). Tantangan penundaan pembayaran klaim BPJS Kesehatan terhadap operasional rumah sakit swasta di Indonesia. Jurnal Kebijakan Kesehatan Indonesia;12(2):101–110.
Putra, A. R., & Hidayat, M. (2023). Sistem klaim asuransi kesehatan dan potensi fraud dalam program JKN: Kajian dari perspektif kebijakan publik. Jurnal Ekonomi dan Kebijakan Publik;14(1):55–68.
Kementerian Keuangan RI. (2023). Strategi Investasi Dana Jaminan Sosial Kesehatan dalam Pembangunan Nasional. Jakarta: Kemenkeu RI.
Otoritas Jasa Keuangan. (2022). POJK No. 85/POJK.05/2022 tentang Tata Kelola Investasi Dana Jaminan Sosial. Jakarta: OJK.
OECD. (2021). Public Social Insurance Funds: Governance and Investment in Health. OECD Publishing.
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