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Asia Times
2 days ago
- Health
- Asia Times
A cure for Indonesia's ailing and corrupt health system
The Jaminan Kesehatan Nasional (JKN), Indonesia's single-payer health insurance, faces a looming deficit potentially amounting to 25 trillion rupiah (US$1.54 billion) as of 2025, the largest since BPJS Kesehatan (or BPJSK) began managing JKN in 2014. This alarming deficit has sparked public turmoil, with stakeholders suggesting solutions ranging from increasing monthly premiums to reducing coverage for smoking-related diseases. BPJS operates under mandates of UU 40/2004 and UU 24/2011, to administer JKN, Indonesia's universal health coverage program. JKN is financed through premiums: formal workers contribute 5% of their salaries, while informal workers pay according to one of three classes outlined in Perpres 64/2020. The government subsidizes premiums for the impoverished through the Minister of Health. When JKN users receive healthcare, facilities provide care and submit proof to BPJS for reimbursement. Additionally, primary health centers (Puskesmas) and clinics receive a per-person payment for each registered user, known as capitation payment. The models of Indonesia's national health insurance incorporate elements from two globally recognized health insurance models: the Beveridge model from England and the Bismarck model from Germany. The Beveridge model is seen in the National Health Service (NHS), which funds health insurance through government-owned services financed by tax. Conversely, the Bismarck model involves tax contributions deducted from salaries as part of the employee-employer contribution, applicable in both public or private sectors. JKN combines these approaches by collecting premiums through salary contributions and offering services to both the public and private sectors. Among the various factors driving the deficit, fraudulent activities within hospitals are particularly alarming. Several hospitals have been accused of creating false billing or shadow claims – a scheme often coordinated between the director and doctors in the hospital. However, these instances of misconduct represent more than isolated incidents; they are indicative of a deeper systemic issue characterized by an imbalance between funding and utilization of services. The tariffs set for hospitals providing JKN service, as determined by regulators, were considered insufficient by the hospitals themselves. Despite a revision in 2023, as indicated by the Ministry of Health Decree 3/2023, the updated tariffs were still perceived as inadequate. In response, the government increased the tariff in 2024, but only for Class A hospitals. This chronically underestimated tariff compels hospitals to adjust their practices. Some facilities discharged patients while still in compromised health—a practice that was eventually prohibited by BPJS. Moreover, certain hospitals engaged in patient 'cherry-picking' by selecting individuals with less severe conditions to reduce the length of stays and associated costs. Some seemingly unfortunate circumstances initially yielded positive outcomes for JKN and BPJSK, albeit briefly. During the Covid-19 pandemic, patients were compelled to stay at home to minimize the risk of contracting the virus. As a result, many refrained from using JKN services, which in turn relieved BPJS of the financial burden of hospital payments, ultimately leading to a surplus during the pandemic. However, as the pandemic subsided and service resumed, the usage of healthcare services rebounded. This resurgence increased BPJS's payments to hospitals, surpassing the expenditure levels during the pandemic. This complex phenomenon ultimately necessitates a comprehensive evaluation of the service provided under JKN by health facilities. It is essential to establish a transparent and timely surveillance and monitoring system focused on detecting fraudulent activities. Additionally, the formalization of entities responsible for managing fraud risks should be a priority. JKN has already set up a dedicated JKN Fraud Prevention team (Tim Pencegahan Kecurangan Jaminan Kesehatan Nasional ) , and it is essential to ensure both its operational capacity and robust governance to mitigate any potential conflict of interest. Beyond internal measures, external sanctions can also deter fraudulent activities. Current regulations allow for the revocation of medical permits for ethical violations. However, these primarily target individuals. Instituting broader institutional sanctions once fraud is proven can enhance accountability across the healthcare system. Indonesia's approach to managing its healthcare system must evolve to address both current inefficiencies and emerging challenges. This involves not only enhancing the integrity of financial transactions and service delivery within JKN but also fostering a healthcare ecosystem that supports ethical practices and robust financial management. As Indonesia navigates its path towards sustainable healthcare, the integration of stringent financial controls, coupled with an ethical healthcare delivery system, will be paramount. By reinforcing the structural and ethical foundations of its national insurance system, Indonesia can ensure that JKN not only survives but thrives, providing comprehensive and equitable healthcare coverage to all its citizens. The journey ahead is complex, but with concerted effort and strategic reforms, Indonesia can hopefully transform its healthcare landscape into a model for other developing nations and ultimately achieve universal health coverage amidst financial constraints and operational challenges. Ryan Rachmad Nugraha is an assistant professor at the Department of Family and Community Medicine, Universitas Gadjah Mada, specializing in primary care management. Ahmad Novindri Aji Sukma is an Indonesian Lawyer and PhD researcher at the University of Cambridge, specializing in Law & Criminology.
The Star
12-05-2025
- Health
- The Star
HFMD cases more than triple compared to same period last year, says Health Ministry
PETALING JAYA: The number of hand, foot and mouth disease (HFMD) cases has more than tripled so far in 2025 compared to the same period in 2024, says the Health Ministry. It said there were 99,601 cases reported as of the 17th epidemiological week, a 266% increase compared to 27,236 cases during the same period last year. To date, no fatalities related to the disease have been reported. "Of the total cases this year, 10,421 cases or 10% were outbreak-related, while 90% or 89,180 cases occurred sporadically," the ministry's disease control division said in a statement on Monday (May 12). Selangor reported the highest number of HFMD cases with 27,118 cases, followed by Johor (9,864 cases); Perak (9,347); Kelantan (7,147); and Kuala Lumpur and Putrajaya (6,850) The division also found that 2,649 outbreaks were reported so far, an increase of 49% compared to 1,339 outbreaks during the same period in 2024. "Of these outbreaks, 578 occurred at nurseries followed by 480 outbreaks at kindergartens, government-run preschools or tabika (292) and 251 at preschools," it said. The ministry also said 38,285 premises across the country were inspected, including nurseries, kindergartens, government-run preschools, preschools and residential homes. "Of these, 1,140 premises were ordered to close under the Prevention and Control of Infectious Diseases Act 1988 while 430 closed voluntarily. "In addition, 220 town-hall sessions and briefings have been conducted across the country by the state health departments (JKN) and district health offices to provide health education aimed at curbing the spread of HFMD," it said. The Health Ministry also advised parents and guardians to practice prevention measures such as washing hands before eating or after using the washroom. This includes ensuring toys, toilets and frequently used items are cleaned periodically using soap or disinfectants. "Personal items such as cups, towels and toothbrushes should not be shared. Children displaying symptoms must seek medical treatment immediately and not attend childcare centres or public places," it said. Further information on HFMD can be found at and the ministry's official Facebook page.
