Axis Capital, Bermuda: A history of

healthcare in Indonesia

Local governments initially started carrying health insurance back in 2003 when Megawati
Soekarnoputris government presented the Health Service Insurance for Poor Families program,
or JPK-Gakin. The notion was for district managements to apply their personal community
health insurance schemes in line with local requirements. Nevertheless, limited programs ever
actually got off the ground before Susilo Bambang Yudhoyonos new government presented a
bill that laid the foundation for a nation-wide program and made JPK-Gakin redundant, Law no.
40/2004 on a National Social Security System (SJSN). Simultaneously, Yudhoyonos government
announced a program to run free, however basic, healthcare to the poor - Askeskin (heath
insurance for the poor), which was substituted in 2008 by Jamkesmas (community health
insurance).

Certain regional administrations put up a round. In 2005, East Javas government led a test at
the Constitutional Court demanding that SJSN gave the central government a monopoly on
social service provision and broke the constitution and Law no. 32/2004 on Regional
Governance. The court approved that SJSN did not stop local governments from emerging their
own social security programs, as well as for healthcare. Ever since, the quantity of local health
insurance programs has increased year on year.

One of the groundbreaking systems was Jaminan Kesehatan Jembrana (JKJ) presented in 2003
by Gede Winasa, the head of Jembrana district in Bali. According to this scheme, all members of
JKJ, may they be poor or non-poor get free primary care from public and private providers.
Residents branded as poor acquire secondary and tertiary care too. Money comes chiefly from
the district budget, with about central and provincial government subsidies. Winasa had
preceding experience in the health sector, equally as a dentist and as a health bureaucrat, and
he was extensively acclaimed for his idea and actual leadership by the media. It appears that
several politicians round the country saw at the good promotional he received, and his fame
with voters, and free healthcare schemes arose to spread.

Many Jamkesda programs bid simple care at community health centres (puskesmas), and
typically just for the poor who arent covered by other programs, resembling the national
scheme Jamkesmas. And reviews propose that because of the above reasons, scams and frauds
sprout. But in resource-rich regions such as Aceh, healthcare programs are far more
openhanded. In 2009 Acehs then Governor, Irwandi Yusuf, presented the Jaminan Kesehatan
Aceh program. Similar to the scheme in Jembrana, JKA bids universal coverage for all residents
of Aceh, and it began a dramatic point in the acceptance of health services with the
consequence that some local hospitals have writhed to manage ever since.

JKA likewise covers almost all illnesses and patients with complex illnesses can be flown to
hospitals in Jakarta to have treatment. Prices are so far about Rp. 400 billion (US$41 million)
per year. Officials on the border of Aceh report that people go over from North Sumatra to get
Aceh identity cards that will let them have free healthcare. The money for JKA comes from
special autonomy funds compensated by the central government as a consequence of the
2005 peace deal that ended the separatist insurgency in Aceh.

At the same time in the poorer regions of Indonesia, local administrations sense bound to bid
some kind of free or heavily subsidized health service. The government introduced an insurance
program that offered free basic care at public hospitals to residents not covered by alternative
schemes, like Jamkesmasinn Kupang, the capital city of one of Indonesias poorest provinces,
East Nusa Tenggara. While in Central Lombok, instead of providing basic healthcare coverage,
the district head assured a much contracted program that covered free maternal health
services to pregnant women.