Determinants of the National Health Insurance Uptake in Indonesia

Abstract

Background: Indonesia introduced a national health insurance program, the so-called Jaminan Kesehatan National (JKN), in 2014 to enhance health access for its citizens. However, unattained universal health coverage (UHC) such as participation target becomes a concern. Aims: This study aimed to examine the factors influencing JKN participation and propose a possible policy improvement to enhance UHC implementation Methods: A systematic review was performed based on PRISMA guidelines, and literature was collected from PubMed, Scopus, Web of Science, Cochrane Library, and Google Search. Results: 21 articles in English and Indonesian language are included in the study after being reviewed using the PRISMA flowchart and quality assessment. The main factors that emerged from the found literature affecting the low enrolment of the NHIS include socio-demographic factors: younger people, low education level, rural location, unstable incomes, and larger family members. Also, health-related, and other factors: lack of health insurance literacy, insufficient healthcare accessibility and services availability, inadequate healthcare service quality, complicated administrative procedure, negative stigma, membership data inaccuracy, and low health status. Conclusion: Twelve factors have been identified as the most influential determinants for the national health insurance program. Some proposed policies derived from the current results might contribute to the attainment of UHC.

Predictors of national health insurance membership among the poor with different education levels in Indonesia

“…Formal education level is often associated with literacy [ 20 , 32 ]. Health insurance literacy, the ability to understand what health insurance is, is a prominent factor in health insurance participation [ 18 ]. A proper understanding of health insurance will lead to a higher acceptance rate for participating in health insurance [ 20 ].…”

“…The lower education population could have difficulty understanding the abrupt and complex change in the NHI mechanism [ 11 , 16 , 32 ]. Higher education and adequate information are two things that are always related to higher health insurance literacy [ 16 , 18 , 32 ]. Thus, it is not surprising that, in several studies, people’s exposure to information sources, such as mass media, is also reported to increase the probability of people with no education background enrolling in a health insurance coverage [ 15 , 33 ].…”

“…Studies in Ghana and Benin that also used national health insurance and exemptions for the poor in paying NHI premiums revealed that the core poor are excluded from the NHI because this population does not understand that they have the right to be funded and does not know the procedures to acquire their privilege as the poor in NHI [ 13 – 15 ]. In Indonesia, individuals unable to understand and fulfil the registration procedure tend not to have a membership, while individuals with better access to information have more benefits in understanding the NHI [ 16 – 18 ]. Studies found that the poor living in an urban area, where the NHI information is easily accessed, are reportedly more likely to be enrolled [ 11 , 19 ] as were the poor who accessed the internet [ 20 – 22 ].…”

Maternal Death, Quality Services, and Mental Health: A Cycle or Repeated Episode ?

“…The National Health Insurance does help a lot, but who will help JKN from a deficit if there are many cases of diseases that require huge costs. A systematic review conducted by Muhlis (2022) found that the low level of participation in the JKN program was due to various multidimensional factors. This factor is not only related to the ability to pay contributions, but many are due to individual and environmental internal factors.…”