MUTU LAYANAN DALAM UNIVERSAL HEALTH COVERAGE INDONESIA DAN PERAN MEKANISME PEMBAYARAN JKN: PEMBELAJARAN STRATEGIC PURCHASING NHS INGGRIS

Nazwa Fadya Nur Shaumi; Amanda Nurjanah; Dwi Rani Oktapiani; Riswandy Wasir

doi:10.35328/kesmas.v15i1.3259

Authors

Nazwa Fadya Nur Shaumi Universitas Pembangunan Nasional “Veteran” Jakarta, Depok, Indonesia
Amanda Nurjanah Universitas Pembangunan Nasional “Veteran” Jakarta, Depok, Indonesia
Dwi Rani Oktapiani Universitas Pembangunan Nasional “Veteran” Jakarta, Depok, Indonesia
Riswandy Wasir Universitas Pembangunan Nasional “Veteran” Jakarta, Depok, Indonesia

DOI:

https://doi.org/10.35328/kesmas.v15i1.3259

Keywords:

Benefit_package, cost _sharing, efficiency, financial_protection, JKN, patient_costs

Abstract

The implementation of Universal Health Coverage (UHC) through the National Health Insurance (JKN) program aims to improve access to and quality of healthcare services in Indonesia. However, its implementation still faces challenges related to service quality and healthcare financing effectiveness. This study aims to analyze the quality of UHC services in Indonesia and the role of JKN payment mechanisms through comparison with the healthcare system in England. The method used was a literature review of scientific articles obtained from PubMed and Google Scholar. The findings showed that JKN has improved financial protection for the population, although out-of-pocket (OOP) expenditures remain relatively high among vulnerable groups. In addition, payment mechanisms such as INA-CBGs influence the efficiency and quality of healthcare services. Therefore, strengthening payment systems, quality monitoring, and equitable access to healthcare services are needed to improve the implementation of UHC in Indonesia.

References

Cheng, Q., Fattah, R. A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., et al. (2025). Determinants of healthcare utilization under the Indonesian national health insurance system: A cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-024-11951-8

Feng, Yan, Søren Rud, Paula Lorgelly, Rachel Meacock, Alberto Núñez, Marina Rodés, Sánchez Luigi, and Siciliani Matt. 2024. “Pay ‑ for ‑ Performance Incentives for Specialised Services in England : A Mixed Methods Evaluation.” The European Journal of. https://doi.org/10.1007/s10198-023-01630-6

Friebel, R., Molloy, A., Leatherman, S., Dixon, J., Bauhoff, S., & Chalkidou, K. (2018). Achieving high-quality universal health coverage: A perspective from the National Health Service in England. BMJ Global Health, 3(6), e000944. https://doi.org/10.1136/bmjgh-2018-000944

Gloria, Netha, Br Ginting, and Dewi Agustina. 2023. “Implementasi Jaminan Kesehatan Daerah Untuk Mencapai Universal Health Coverage ( UHC ) Dalam Pelayanan Kesehatan Puskesmas Di Puskesmas Teladan Kota Medan.”

Hughes, H., & Churchill, N. (2017). Speaking up in the NHS in England: The work of the National Guardian and NHS England. Future Healthcare Journal, 4(3), 198–199.

Keown, P., Alder, R., Wild, G., Ouma, L., McKinnon, I., & Weich, S. (2025). Long term trends in NHS inpatient bed provision in England, 1960–2020. PLOS One. https://doi.org/10.1371/journal.pone.0330931

Leslie, H. H., Sun, Z., & Kruk, M. E. (2017). Association between infrastructure and observed quality of care in four healthcare services: A cross-sectional study of 4,300 facilities in eight countries. PLoS Medicine, 14(12), e1002464.

Maulana, N., Soewondo, P., & Limasalle, P. (2022). How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia. PLOS Global Public Health, 2(8), e0000203. https://doi.org/10.1371/journal.pgph.0000203

Nugraheni, W. P., & Hartono, R. K. (2016). Determinan pengeluaran kesehatan katastropik rumah tangga Indonesia pada tahun pertama implementasi program JKN. Media Penelitian dan Pengembangan Kesehatan, 26(1), 27–36.

NHS Digital. (2024). Quality and outcomes framework, 2023–24. https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/2023-24

NHS England. 2024. “Quality and Outcomes Framework Guidance For.” (April).

Ridwan, Adam. 2022. “SCIENTIA : Journal of Multi Disciplinary Sciences Analisis Mutu Layanan Kesehatan Dalam Perspektif Implementasi JKN SCIENTIA : Journal of Multi Disciplinary Sciences.” 01(1): 1–16.https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2024-25/

Ridwan, A. (2022). Analisis mutu layanan kesehatan dalam perspektif implementasi JKN. Scientia: Journal of Multi Disciplinary Sciences, 1(1), 1–16.

Saragih, H. W., & Simarmata, M. (2025). Analysis of the effectiveness of national health insurance (JKN) financing on the quality of services in first-level health facilities. Journal of Public Health Research, 3(2), 293–302.

World Health Organization. (2018). Delivering quality health services: A global imperative for universal health coverage. World Health Organization.

World Health Organization, & World Bank. (2023). Tracking universal health coverage: 2023 global monitoring report. World Health Organization.

Yanful, Bernice, Abirami Kirubarajan, Dominika Bhatia, Sujata Mishra, Sara Allin, and Erica Di Ruggiero. 2023. “Quality of Care in the Context of Universal Health Coverage : A Scoping Review.” Health Research Policy and Systems: 1–29. doi:10.1186/s12961-022-00957-5.