The maternal mortality rate in Indonesia is still high, at 305 per 100,000 live births. Several studies indicated maternal financial burden as one of the dimensions of access that influence a pregnant woman's ability to receive adequate, high-quality medical care. This study aims to identify the association between the use of Indonesia's national health insurance (JKN) and out-of-pocket (OOP) expenditures in accessing delivery services, using data from the Indonesian Family Life Survey 5. In addition, this study also investigated the relationship of JKN and the potential reduction of catastrophic delivery expenditures (CDEs) for delivery services. The results show that JKN was associated with reduced OOP expenditures for delivery as well as reduced risk of incurring CDE. However, some OOP expenditure for cost of delivery services still exists among mothers who used JKN during delivery, potentially due to factors such as medicine stock availability and inpatient care shortages.

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Latar Belakang: Kapasitas SDM kesehatan dan kemampuan pendanaan yang terbatas menjadi ancaman keberlanjutan program Posbindu Penyakit Tidak Menular (PTM). Penelitian ini bertujuan untuk menganalisis strategi penguatan program Posbindu PTM di Kota Bogor.Metode: Desain penelitian merupakan kualitatif dengan pendekatan studi kasus. Informan utama penelitian berasal dari Dinas Kesehatan, Puskesmas, kader, dan masyarakat.Hasil Penelitian: Posbindu PTM kota Bogor telah dikunjungi oleh masyarakat dari kalangan usia muda hingga tua, namun jumlah kader dan peralatan setiap Posbindu berbeda, kader kurang mendapatkan pelatihan dan pendanaan yang belum maksimal.Kesimpulan: Strategi berupa pelatihan yang lebih intensif terhadap kader mengenai PTM dari tenaga kesehatan, penambahan kegiatan kesehatan untuk meningkatkan intensitas kehadiran warga dan kerja sama lintas sektor menjadi alternatif yang dapat diterapkan untuk penguatan program Posbindu PTM.

INTRODUCTION: Since it was implemented in 2014, National Health Insurance Program (JKN) in Indonesia experienced a financial deficit. JKN recorded a deficit of 9.7 trillion, 9.75 trillion and 10.98 trillion rupiah from 2016-2018, respectively. The deficit is estimated to still continue in the upcoming years. Systemic solutions are needed to bring JKN improvement in the future. METHODS: Data was collected from June to December 2019 by in-depth interviews with selected informants and literature review, which later was analyzed by content and with data triangulation. RESULT: The results of in-depth interviews and a review of some of the literature shows that there are four main factors that causes JKN deficit, which are capitation payment system to provider, the alleged fraud, lag of backed-referral system, and catastrophic disease. CONCLUSION: This study provides a solution to the handling of JKN deficits in the short and long term in accordance with problems in terms of funding and JKN expenditure. The solution can be an alternative policy that can be implemented by the Government of Indonesia to deal with the JKN deficit.

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