THE HEALTH POLICY

A. Introduction
Until now, health problems remains a major topic in selurruh world. The
World Health Organization (WHO) and the World Bank Group on 12 June 2015
showed that 400 million people do not have access to essential health services and
6% of people in countries of low and middle income were tipped into or pushed
further into extreme poverty because of health spending. According to the WHO
to address health issues should be in charge of health policy. According to WHO
health policy refers to decisions, plans, and actions taken to achieve certain health
care in the community. Explicit health policy can accomplish several things:
define a vision for the future which in turn helps to set targets and a reference
point for the short and medium term. It outlines priorities and the expected role of
the different groups; and builds consensus and informs people.
So also is the case in Indonesia, the cost of treatment is still considered very
expensive. Therefore, the existence of public health insurance is needed in terms
of health care. To achieve national health insurance establishes health. Therefore,
the Indonesian government issued a policy that clearly regulate health care for
Servants and Pension Recipients (civil and military) and their family members
under Presidential Decree No. 230 Year 1968, the Minister of Health established a
specialized agency within the Ministry of Health is an Operating Body
Maintenance Fund Health (BPDPK), where the Minister of Health at that time
(Prof. Dr. GA Siwabessy) expressed as a forerunner of the National Health
Insurance.
In the period of implementation continues to progress until today. At 1984 the
Government issued Government Regulation No. 22 of 1984 on Health Care for
Civil Servants, Pension Recipients (civil, military and state officials) and their
family members. By Government Regulation No. 23 of 1984, the status of the
organizing body is converted into a Public Company Bhakti Husada. And in 1991
the health insurance on the responsibility of government plus the Veterans and
Independence Pioneers and their family members. In addition, the company is
allowed to expand the reach of membership to business entities and other entities

as voluntary participants. In 1992 refers to Government Regulation No. 6 of 1992

Perum status was changed to Limited Liability Company (PT Persero) with
consideration of the flexibility of financial management, contribution to the
Government negotiated for the benefit of participants and management services to
more independent. In 2005 experienced PT.
Askes (Persero) was given the task by the Government through the Ministry of
Health, according to the Decree of the Minister of Health No. 1241 / Menkes / SK
/ XI / 2004 and No. 56 / Menkes / SK / I / 2005, as Operator's Health Insurance
Program of the Poor (PJKMM / ASKESKIN). Implementation of the 1945 base,
Law 23/1992 on Health, Law No.40 / 2004 on National Social Security System
(Navigation), the Minister of Health No. 1241 / Menkes / SK / XI / 2004 and No.
56 / Menkes / SK / I / 2005. Principles of Implementation refers to held
simultaneously throughout Indonesia with the principle of mutual cooperation
resulting cross-subsidy, referring to the principles of health insurance social,
health services with the principles of managed care be structured and tiered, the
program organized by the principle of non-profit, ensuring protabilitas and equity
in services to participants, the lack of accountability and transparency is assured
by emphasizing the precautionary principle; efficiency and effectiveness. Starting
on January 1, 2014, PT Askes Indonesia (Persero) changed its name to BPJS
accordance with Law no. 24 of 2011 on BPJS.
With this rule change is expected to equal distribution of health can be
realized, so that the health of the health status of the State would be increased.
When at work I use the health insurance BPJS been regulated by Law No. 40 of
2004 on the Social Security and Law 24 of 2011 on BPJS. (BPJS) is a public legal
entity set up to organize the social security program. BPJS consists of BPJS BPJS
Health and Employment. Social Security Agency (BPJS) Health is a statutory
body set up to organize the health insurance program.
Health Insurance is a guarantee in the form of health protection for
participants to benefit health care and protection to meet basic health needs are
given to every person who has paid dues or dues paid by the government. And
also uses BPJS employment provide protection against all risks that caused by
occupational risk and retirement.

B. History of Health Insurance in Indonesia

Since 1968 the government has launched a healthcare costs as seen from those
contained in the history of its development, namely:
1. 1968: The Indonesian government issued a policy that clearly regulate
health care for Servants and Pension Recipients (civil and military) and
their family members under Presidential Decree No. 230 Year 1968, the
Minister of Health established a specialized agency within the Ministry of
Health that the Fund Administering Agency Health Maintenance
(BPDPK), where the Minister of Health at that time (Prof. Dr. GA
Siwabessy) expressed as a forerunner of the National Health Insurance.
2. 1984: To further improve the health care insurance program for
participants and that can be managed in a professional manner, the
Government issued Government Regulation No. 22 of 1984 on Health
Care for Civil Servants, Pension Recipients (civil, military and state
officials) and their family members. By Government Regulation No. 23 of
1984, the status of the organizing body is converted into a Public
Company Bhakti Husada.
3. 1991: Based on Government Regulation No. 69 of 1991, the membership
of health care insurance program managed by Perum Bhakti Husada
coupled with Veterans and Independence Pioneers and their family
members. In addition, the company is allowed to expand the reach of
membership to business entities and other entities as voluntary
participants.
4. 1992: Based on Government Regulation No. 6 of 1992 Perum status was
changed to Limited Liability Company (PT Persero) with consideration of
the flexibility of financial management, contribution to the Government
negotiated for the benefit of participants and management services to more
independent.
5. 2005: PT. Askes (Persero) was given the task by the Government through
the Ministry of Health, according to the Decree of the Minister of Health
No. 1241 / Menkes / SK / XI / 2004 and No. 56 / Menkes / SK / I / 2005,
as Operator's Health Insurance Program of the Poor (PJKMM /
ASKESKIN). Basic Operation of 1945, Law No. 23/1992 on Health, Law
No.40 / 2004 on National Social Security System (Navigation), the
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Minister of Health No. 1241 / Menkes / SK / XI / 2004 and No. 56 /

Menkes / SK / I / 2005.
6. Operation

principle

refers

to:

a. Held simultaneously throughout Indonesia with the principle of mutual

cooperation
b.

resulting

Referring

to

the

principle

cross-subsidy.
of

social

health

insurance.

c. Health services with managed care principles be structured and tiered.

d.

The

program

e.

Protabilitas

and

was

organized

ensure

equity

by
in

the

non-profit

service

to

principle.
participants.

f. Accountability and transparency is assured by emphasizing the principle

of prudence, efficiency and effectiveness.
7. 2014: Starting on January 1, 2014, PT Askes Indonesia (Persero) changed
its name to BPJS accordance with Law no. 24 of 2011 on BPJS.
C. Definition
BPJS Health is the Implementing Agency is a public legal entity
which organizes dibentukuntuk health insurance program for all people.
D. Vision and Mission
1. Vision
No later than January 1st, 2019, the entire population of Indonesia
has a national health insurance for the benefit of health care and protection
in fulfilling the basic needs of health organized by Health BPJS reliable,
superior and reliable
2. Mission
1) Build strategic partnerships with various agencies and
encourage public participation in the expansion of the
coverage of the National Health Insurance (JKN).
2) Run and solidify the health care insurance system that is
effective, efficient and quality to participants through a
partnership with the optimal health facilities.
3) Optimizing the management of social security funds and
funds programs BPJS effective, efficient, transparent and
accountable to support the sustainability of the program.
4) Develop an effective Health BPJS based on the principles
of good corporate governance and improve the competence
of employees to achieve superior performance.

5) Implement and develop a system of planning and

evaluation, assessment, quality management and risk
management over the entire operation of BPJS.
6) Develop and strengthen information and communication
technologies to support the operationalization BPJS Health.
E. Organizers Health Services
Health care providers include all health facilities that collaborates with health
BPJS better health facilities owned by the Government, Local Government, and
the private sector to meet the requirements through the process kredensialing and
rekredensialing
F. The Insured
1. Everyone, including foreigners who work for a minimum of 6 (six)
months in Indonesia, which has been paying dues, including:
Beneficiaries Health Insurance Contribution (PBI): the poor and
people can not afford, with the determination of the participants in
accordance

with

legislation.
2. Non Beneficiaries Health Insurance Contribution (Non PBI),
comprising
from :
1) Wages of workers and members of their families Recipients:
Government employees,TNI members, Members of the
Police,State

officials,

Government

Employees

non

Servants,Private employees; and Workers who do not include

the letters asdf who receive wages.
2) Not workers and members of their families: Investors and
Employer
3) Retirement receiver, comprising: Civil Servants who quit with
pension rights, Members of the Indonesian National Army
(TNI) and the Indonesian republic Police (INP), which stops
the pension rights, State officials were stopped with pension
rights, Widows and widowers or orphans of pensioners who
receive pension rights, Other pension recipients, and the

widow, widower or orphan from other pension recipients who

receive pension rights, Veteran, pioneer Independence, Widow,
widower or orphan of a Veteran or Independence Pioneers,
Workers who are not able to pay dues.
Universal health insurance is expected to start gradually in 2014
and in 2019, Indonesia is expected that all citizens already have health
insurance.
G. The Borne Family Members
1. Receiver worker Wages: The nuclear family, including wife /
husband and children

are legitimate (biological children,

stepchildren and / or adopted children), a maximum of 5 (five)

people. Biological children, stepchildren of a valid marriage.
2. Not or have never been married or do not yet have their own
income was 21 (twenty-one) years old or not yet 25 (twenty-five)
years of formal education is still continuing.
3. ot Receiver Wage Workers and Non Workers: Participants can
include

family

members

who

desired

(unlimited).
4. Participants can include additional family members, which include
the 4th child and so on, father, mother and in-laws
5. Participants can include additional family members, which include
other relatives such as siblings / in-law, household assistants, etc.
H. Contribution
1. For participants Beneficiary Contribution (PBI) Health Insurance
dues paid by the Government.
2. Contribution to the participants of Labor Wage Recipients who
works at the Institute of Government consists of the Civil Service,
members of the military, members of the police, state officials, and
employees of non-government civil servants by 5% (five percent)
of the salary or wages per month with the following provisions: 3
% (three percent) is paid by the employer and 2% (two percent) is
paid by the participants.
3. Contribution to the participants of Labor Wage Recipients who
work in state-owned enterprises, and private enterprises of 4.5%

(four point five percent) of the salary or wages per month provided
that: 4% (four percent) paid by the Employer and 0.5 % (zero point
five percent) is paid by the participants.
4. Fees for additional family workers Wage Recipients consisting of 4
onwards to the child, father, mother and in-laws, the amount of
dues amounting to 1% (one percent) of the salary or wages per
person per month, paid by workers wage earners.
5. Fees for other relatives of the workers wage earners (such as
sibling / in-law, household assistants, etc.); participants not worker
wage earners as well as the contributions of participants not worker
is:
a. Amounting to Rp.25.500, - (twenty five thousand five
hundred rupiah) per person per month with service benefits
in the treatment room Class III.
b. Amounting to Rp.42.500 (forty-two thousand five hundred
rupiah) per person per month with the benefits of services
in Class II treatment rooms.
c. Amounting to Rp.59.500, - (fifty-nine thousand five
hundred rupees per person per month with service benefits
in the treatment room Class I.
6. Contribution Health Insurance for

Veterans,

Independence

Pioneers, and the widow, widower or orphan of a Veteran or

Independence Pioneers, the fee was set at 5% (five percent) of 45%
(forty five percent) basic salary of Civil Servants group space III / a
with tenure of 14 (fourteen) years per month, paid by the
Government.
7. Payment of dues no later than 10 (ten) each month
I. Health Facilities
Health facilities in collaboration with Health BPJS consists of:
1. Health Facilities First level:
a. Community Health Center (Puskesmas)
b. medical practices
c. Dentists
d. The first clinic
e. Hospital type D
2. Health facilities belonging to the Indonesian National Army (TNI)
a. au. Army: Polyclinic health and health posts.
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b. Navy: Health Centres A and D, Balai

c. Air Force: Air Force Health Section, Health Institute of
Aeronautics and Space (Laksepra) and Institute of Dental &
Oral Health (Lakesgilut).
d. Health facilities belonging to the Indonesian National Police
(INP), consists of the Parent Clinic Police, Police General
Polyclinic, Polyclinic Others belong to the National Police and
The Care Temporary (TPS) INP
3. Advanced Health Facilities:
a. Hospitals, consisting of General Hospital (RSU), General
Hospital Central Government (Dr), RS Government General
(Hospital),
Bhayangkara

Hospital
(INP),

General
General

TNI,
Hospital

General
Private,

Hospital
Special

Hospitals, Special Hospitals Heart (Cardiovascular ), Special

Hospital Cancer (Oncology), Special Hospital Lung, Eye
Specialty Hospital, Maternity Specialty Hospital, Leprosy
Special RS, RS Special Soul, Other Specialty Hospital
accredited, RS Moving and field.
b. Health centers, consisting of: Public Lung Health Center,
Community Eye Health Institute, Center for Maternal and
Child Health and the Center for Mental Health.
4. Supporting the health facilities that do not work directly with BPJS but
a network of first-level health facilities and health facility level in
cooperation with BPJS anjutan Health, include: Health Laboratory,
Pharmacy, Blood Transfusion Unit, optics.
J. MANFAAT AKOMODASI RAWAT INAP
1. Class III treatment room for:
a. Participants PBI Health Insurance;
b. Participants Workers Not Receiver Wages and participants
not worker with a contribution for benefits in the treatment
room service class III.
2. Class II Treatment room for:
a. Civil Service and the Civil Service pension recipients
chamber group I and group II space and their family
members;

b. TNI members and members of the military pension

recipients equivalent Civil Servants class I and class room
space II and their family members;
c. Police and members of the police pension recipients
equivalent Civil Servants space group I and group II space
and their family members;
d. Participants Workers Wage

Recipients

and

Non-

Government Servants Employees with salaries or wages of

up to 1.5 (one half) times the income is not taxable to the
status of mating with one (1) child, and their family
e.

members; and
Participants Workers Not Receiver Wages and participants
not worker with a contribution for benefits in the treatment

room services class II;

3. First class treatment room section.
a. State officials and their family members;
b. Civil servants and the civil servants pension recipients
chamber group III and group IV space and their family
members;
c. TNI members and members of the military pension
recipients equivalent Civil Servants space group III and
group IV space and their family members;
d. Police and members of the police pension recipients
equivalent Civil Servants space group III and group IV
space and their family members;
e. Veterans and Independence Pioneers and their family
members;
f. widow, widower or orphan of a Veteran or Independence
Pioneers;
g. Recipients of the monthly wages of participants Workers
and Employees of Non-Government Servants with salaries
or wages above 1.5 (one half) of up to two (2) times the
income is not taxable to the status of mating with one (1)
child, and their family members

h. Peserta Workers Not Receiver Wages and participants not

worker with a contribution for benefits in the treatment
room service class I.
K. Health Care Guaranteed
1. Health Services First Level Primary health care that including nonspecialist health services that include: administration services, Promotive
and preventive, Examination, treatment, and medical consultation, Nonspecialist medical action, both operative and non-operative, drug services
and medical materials consumables, Blood transfusion in accordance with
medical needs, Laboratory diagnostic investigations pratama level,
Hospitalization of First Instance in accordance with the medical
indications.
2. Advanced level referral health services, including health care outpatient
and inpatient care, which includes: administration services, Examination,
treatment and specialist consultations by specialists and subspecialists,
Specialist medical procedures, both surgical and non surgical according to
medical indication, Drug services and medical materials consumables,
Advanced diagnostic support services in accordance with the medical
indications, medical rehabilitation, blood service, Forensic medicine
services clinic, Services corpse in a patient who died after being
hospitalized in health facilities in cooperation with BPJS health, such as
the bodies pemulasaran excluding coffin and hearse, Non intensive
inpatient care, Hospitalization in intensive care.
3. Labor.
Health BPJS borne deliveries in health facilities of First Instance or
Advanced is up to the third child labor, regardless of the child's life /
death.
4. Ambulance.
In the operation of ambulance services, health facilities can cooperate with
a third party as networking, among others: Local Government or
Provincial Health Office to have an ambulance, ambulance 118,
Foundation ambulance service providers
L. Flow Health Care

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The first is that participants have to go to a health facility first, when in need
of intensive action and can not be done in this health facility it will be ascribed to
the second fasilits, unless in emergencies.
Procedures to Get Health Care
1. First Level Health Care
a. Each participant must be registered on the first level health
facility that has been working with Health BPJS.
b. Participants receive medical care at first-level health facilities
where participants registered.
c. Participants can obtain inpatient care at first-level health
facilities in accordance with the medical indications.
2. Advanced Health Care
a. Participants come to BPJS Center Hospital by showing
participant card and submit a referral letter from the First Level
Health Facilities / warrant control post-hospitalization.
b. Participants receive a Letter of Eligibility Participants (SEP)
for advanced services.
c. Participants can obtain inpatient care at health facilities in
accordance with the advanced level of medical indications.
3. Care & E (Emergency):
a. Emergency Services are health services that should be provided
as soon as possible to prevent death, severity or disability,
according to the ability of health facilities.
b. Participants who require emergency services can directly obtain
service in every health facility.
c. Criteria for emergencies in accordance with applicable
regulations.
d. Participants who receive health care in health facilities who do
not cooperate with BPJS Health, will be immediately referred
to health facilities in collaboration with Health BPJS an
emergency after emergency.
e. resolved and the patient's condition can be moved.
f. Costs due to emergency services billed directly by the Health
Fasiltas BPJS Health.
4. Health Services That Do Not Guaranteed
a. Health services were performed without going through the
procedures as stipulated in applicable regulations.

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b. Health services carried out in health facilities in collaboration

with Health BPJS, except in emergencies
c. Health services has been guaranteed by the program of work
injury insurance against illness or injury due to accidents or
employment relationship to values covered by accident
insurance program
d. Health services guaranteed by the traffic accident insurance
program mandatory until a value is borne by the traffic accident
e.
f.
g.
h.
i.

insurance program
Health services are performed abroad
Health care for aesthetic purposes
Services to overcome infertility
Leveling service dentistry (orthodontics)
Health disorders / diseases caused by drugs and or alcohol

dependence
j. Health problems from accidentally hurting yourself, or as a
result of a hobby which endanger yourself
k. Complementary medicine, alternative and traditional, including
acupuncture, shin she, chiropractic, which has not been
declared effective by health technology assessment (health
technology assessment)
l. Treatment and medical actions that are categorized as an
experiment (experimental)
m. Contraceptives, cosmetics, baby food and milk
n. Household health supplies
o. Catastrophic health care in emergency relief, extraordinary
events / outbreaks.
p. Cost of other services that are not related to health insurance
benefits are provided.
5. Accountability BPJS Health
Health BPJS obliged to pay health facilities for services provided
to participants no later than 15 (fifteen) days from the claim documents
received in full. The amount of payments to health facilities is
determined by agreement between the association BPJS Health and
Health Facilities in the region with reference to the standard rate set by
the Minister of Health. In case there is no agreement on the amount of
the payment, the Minister of Health to decide the amount of payment
for a given program JKN.
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6. Payment Method Health Facilities

Health BPJS will pay to the first-level health facilities. All health
facilities although not cooperating with BPJS shall serve patients in a
state of emergency, after the state of emergency is resolved and the
patient's distress can. Health BPJS will pay to the health facilities that
do not cooperate after providing emergency services equivalent to the
rates prevailing in the region.
M. Monitoring And Evaluation
Monitoring and evaluation of BPJS is part of a quality control system and
cost. This activity is the responsibility of the Minister of Health in coordination
with the implementation of the National Health Insurance Council.

Referance:
BPJS ( 2010 ), Vision and Mission of the Agency of Social Security, http://www.bpjskesehatan.go.id/bpjs/index.php/pages/detail/2010/2
Health BPJS, (2015) . Participant guide BPJS Health Services. Retrived Desember
20,2015 From www.bpjs-Kesehatan.go.id
BPJS, Participants BPJS Service Guide For Health.
Lestari, Andayani Budi ( 2013 ). Role of the National Health Insurance & Health
BPJS.

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WHO, http://www.who.int/topics/health_policy/en/

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