Towards UHC in Indonesia: Kampung Sehat competition to increase participation of BPJS Kesehatan

Abstraksi

The Indonesian National Health Insurance Scheme (BPJS Kesehatan) is one of the most breakthrough policies that Indonesia has adopted in the past 73 years. BPJS aims to provide Universal Health Coverage (UHC) to all Indonesians, which is fundamental, not only to provide citizens’ rights to health services, but also to progress human capital development. However, there are some key challenges to realise UHC, which one of them is the suboptimal participation of BPJS Kesehatan’ memberships. In fact, there are 60 million people who have yet to participate in BPJS by late 2018. As BPJS serves as an end and means at the same time, it is crucial to find creative solutions as an attempt to solve its participation rate issue. This paper aims to shed lights on two research questions, which are, first, what factors affecting suboptimal participation rate of BPJS Kesehatan, and second, how we could potentially address those issues, increase participation rate, and in the medium run to realise UHC. This paper uses qualitative research methodology, which aims to understand the root cause problems of suboptimum penetration of BPJS Kesehatan in Indonesia. As the data collection techniques, this research uses literature review and in-depth interviews with a number of citizens who yet to register to BPJS Kesehatan in Bogor, Makassar, Pangkajene and the archipelago, and Sangihe and the archipelago. In-depth interviews are undertaken through internet-based communication channel and only to limited number of people in four districts, of which can be seen as limitations of this paper. Whilst this research need a further study, both literature review and in depth interviews have provided a baseline for initial deep thought in approaching this issue. Another limitation of this paper is its scope: this paper does not aim to address structural barriers that hamper people to participate in BPJS Kesehatan, which researcher believes will need different approach and solutions. The problem of suboptimal participation of BPJS Kesehatan could be traced down to lack of trust and cooperation among actors and institutions that involved in the system, especially between citizens and state. Theory of the Prisoner's Dilemma is used to explain why some people do not want to participate in BPJS: some people decide not to join BPJS because they do not want to subsidise other people and yet to see the value of joining BPJS. As such, these people decided to opt-out or use private insurance as a dominant strategy to maximise their own utilities. As there is an issue with trust and cooperation, what we should do is increasing level of trust, which can be achieved only if everyone on board and have the same level of information. As such, solution that this paper offers is a sub-district/kampung level competition to realise UHC, called ‘Kampung Sehat Indonesia’, which mobilise community to participate in BPJS Kesehatan by the use of incentivise-based mechanism and assist community to address local context-specific barriers. Kampung Sehat Indonesia would be complemented by sharing and learning forums amongst kampung across regions, both face to face or through technological based, that aims to share useful information to achieve the common goal of UHC for all Indonesians and Indonesia Emas 2045.