Expanding Healthcare Access through the Private Sector: Indonesia’s National Health Insurance and Private Hospitals

Indonesia’s national health insurance scheme (Jaminan Kesehatan Nasional, or JKN) is a key element of the Government of Indonesia’s commitment to ensuring equitable access to healthcare, especially for the poor and the near-poor. JKN’s contracting with private providers was expected to expand reach faster than solely working through the public sector. The single-payer agency for JKN, Badan Penyelenggara Jaminan Sosial-Kesehatan (BPJS-K), contracts private clinics under capitation and pays hospitals through case-based groups. In September 2017, 60 percent of BPJS-K-contracted hospitals were private. How has the single payer and its associated policies affected these private hospitals?

This analysis, conducted by the U.S. Agency for International Development (USAID)-funded Health Policy Plus (HP+) project and the National Team for the Acceleration of Poverty Reduction (TNP2K), asked how private hospital capacity, utilization, and finances have changed since JKN began. We also assessed whether providers perceive reimbursement processes to be fair.