EVOLUSI DAN TANTANGAN SISTEM ASURANSI SOSIAL KESEHATAN DI INDONESIA: KAJIAN PUSTAKA ATAS REGULASI, CAKUPAN, DAN KEBERLANJUTAN FINANSIAL

Abstract

The National Health Insurance (JKN) programme, launched on 1 January 2014, marked a fundamental transformation of Indonesia’s social health insurance system from a fragmented scheme to a single system managed by BPJS Kesehatan. This article aims to analyse the evolution of regulations, the achievement of enrolment coverage, and the challenges to the financial sustainability of the JKN through a literature review using a descriptive qualitative approach. The research findings indicate that the JKN has succeeded in achieving near-universal coverage with 278.1 million participants (98.45 per cent) by the end of 2024, exceeding the Universal Health Coverage (UHC) target. However, the programme faces a structural financial crisis, with a recurring deficit rising from Rp7.14 trillion (2024) to IDR17.13 trillion (2025), a claims ratio above 100 per cent (108.27 per cent in 2025), and the erosion of the Health Social Security Agency’s (DJS Kesehatan) assets from IDR50 trillion to IDR25.4 trillion in less than two years. The root causes of the deficit are multidimensional, encompassing a fundraising gap (58.32 million inactive participants and outstanding contributions of IDR21.48 trillion), pooling failure, and purchasing inefficiency (medical inflation of 10–15 per cent per year and the burden of catastrophic illnesses, which account for more than 50 per cent of claims). Without holistic reforms encompassing proportional contribution adjustments, strengthened contribution compliance, reform of the provider payment system, and an adequate commitment to the health budget, the risk of BPJS Kesehatan’s bankruptcy in 2026–2027 threatens access to healthcare for hundreds of millions of participants.