Review of Current Health Insurance Systems in Indonesia:
Equity Perspectives
Author: Hasbullah Thabrany
University of Indonesia
Currently Indonesia has five categories of health insurance system that cover about 16% of the 203 million people. In term of coverage, Indonesia is far behind among other developing countries in South East Asia. The five categories are: social health insurance schemes for civil servants (Askes), conditional mandatory health insurance for private employees (Jamsostek), traditional commercial health insurance schemes, managed care schemes (JPKM), and employer provided health care. The Askes and Jamsostek cover about 17 million people, or about 8% of the population. The Askes premium is 2% of monthly basic salary while premiums for Jamsostek is 3% of monthly salary for singles and 6% for married employees up to monthly income of one million rupiah (about US$ 100). Due to limitation of data, Kakwani index was not calculated. Limited Lorentz curve is provided by simulating out of pocket expenses of Askes members using Susenas data. Various sources of incomes earned by civil servants and salary cap for premium calculation in Jamsostek scheme have made the two social health insurance schemes regressive. The traditional health insurance schemes cover about five million people and all licensed managed care schemes (JPKM) cover less than one million people. Since the nature of traditional health insurance and managed care products (JPKM) is a commercial health insurance using risk-based premium, the categories are the most regressive health care financing systems. Health benefits provided by employers vary widely that is very difficult to assess the equity aspects. Only Askes and Jamsostek schemes potentially provide horizontal equity in health care financing. Because of rapid expansion of commercial health insurance coverage, horizontal inequity is becoming wider in health care financing in Indonesia.
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