Focus

Jurnal Jaminan Kesehatan Nasional (JJKN) provides an academic forum dedicated to advancing research, policy, and practice to enhance the effectiveness and sustainability of Indonesia’s National Health Insurance system. JJKN publishes original research articles and scholarly reviews that examine key aspects of universal health coverage, with a particular focus on risk pooling mechanisms, membership administration, strategic purchasing, payment methods, healthcare quality, tariff standardization, revenue collection, premium compliance, stakeholder engagement, and institutional capacity. The journal also addresses emerging challenges such as implementing standardized inpatient classes, performance-based capitation models, and strategies for improving participant health history screening. By engaging researchers, policymakers, and healthcare professionals, JJKN seeks to make a meaningful contribution to national and global discourse on optimizing health insurance systems and advancing equitable, sustainable access to healthcare.

Scope

To realize a resilient, equitable, and sustainable national health insurance system, several interrelated domains must function effectively. JJKN highlights five key focus areas that are essential to this goal, including Risk Pooling, Strategic Purchasing, Revenue Collection, Stakeholder Engagement, and Institutional Capability. Each domain comprises critical subtopics that reflect current challenges, innovations, and best practices in the implementation of national health insurance, as detailed below.

1. Risk Pooling

• Coverage Expansion
  Ensuring broader population enrollment is essential to increase risk-sharing and reduce adverse selection. Expanding coverage to informal sectors and vulnerable groups strengthens the financial base of the system and enhances equity in access to healthcare.

• Customer Service
  High-quality customer service is vital to maintain public trust and participant satisfaction. It influences continued participation and reduces dropouts, which in turn sustains risk pooling effectiveness.

• Membership Administration
  Efficient administration supports accurate participant data, eligibility verification, and seamless service access. Weak membership systems can result in delays, fraud, or service denial, undermining system performance.

2. Strategic Purchasing

• National Health Insurance Benefits
  Designing appropriate benefit packages is critical to meet population health needs while remaining financially sustainable. Misaligned benefits can lead to underutilization or unnecessary cost burdens.

• Payment Methods
  Choosing the right payment mechanisms (e.g., capitation, fee-for-service, DRG) is essential to incentivize providers, control costs, and ensure service quality. Ineffective payment models may lead to overspending or compromised care.

• Quality of Health Service
  Monitoring and improving healthcare quality safeguards patient outcomes and ensures value for money. Poor quality care diminishes public confidence and reduces the effectiveness of insurance coverage.

• Health Care Tariff Standardization
  Establishing fair and consistent tariffs prevents provider disputes and promotes transparency. Without standardization, there is a risk of price variability, inefficiency, and inequitable service delivery.

• Cooperation and Health Facility Compliance
  Maintaining partnerships with compliant healthcare providers ensures that insured participants receive services according to contractual standards. Non-compliance threatens patient safety and insurance credibility.

• Health Service Policy
  Sound policy frameworks guide purchasing decisions and align them with health system goals. Inadequate policies can result in fragmented service delivery and financial inefficiency.

• Fraud Mitigation
  Combating fraud is essential to protect public resources and maintain the integrity of the insurance system. Fraudulent practices undermine trust, waste funds, and compromise service quality.

3. Revenue Collection

• Premium Income
  Reliable and sufficient premium income is the financial foundation of NHI. Low or unstable premium collection limits the system's ability to provide comprehensive coverage and pay for services on time.

• Premium Receipt
  Accurate recording and acknowledgment of premium payments are crucial for transparency and participant trust. Errors or inconsistencies in receipts can cause disputes and disrupt coverage.

• Premium Collectability
  The ability to collect premiums effectively, especially from the informal sector, determines system solvency. Low collectability rates threaten financial sustainability and increase the need for subsidies.

• Payment Channel Expansion
  Providing diverse and accessible payment channels improves convenience, particularly in remote or underserved areas. Without adequate options, premium payment compliance may decline.

• Premium Payment Compliance
  Ensuring participants pay their premiums regularly and on time is necessary for continuous coverage and financial health. Non-compliance can lead to service interruptions and revenue shortfalls.

4. Stakeholder Engagement

• Regional UHC Commitment
  Strong local government support is key to expanding access and aligning regional programs with national goals. Lack of commitment at the regional level can hinder UHC achievement.

• Inter-agency Policy Integration
  Coordinated efforts among institutions promote consistent policies and efficient program delivery. Disjointed policies create confusion and reduce program effectiveness.

• Stakeholder Partnerships
  Active collaboration with healthcare providers, civil society, and private entities enhances system resilience and responsiveness. Weak partnerships may result in resistance to reforms and limited innovation.

5. Institutional Capability

• Human Resource and General Affairs
  A competent and well-managed workforce is essential for operational efficiency and policy execution. Human resource shortages or mismanagement can lead to service delays and policy failures.

• Information Technology
  Robust digital infrastructure supports data accuracy, fraud prevention, and real-time decision-making. Outdated or fragmented IT systems compromise efficiency and service quality.

• Organizational Governance
  Effective governance structures ensure accountability, transparency, and strategic alignment. Poor governance leads to inefficiencies, weak oversight, and reputational damage.

(Update: 14 July 2021)