Economic Enabling Factors and the Sustainability of Indonesia’s National Health Insurance: Evidence from Hospital Utilization
Keywords:
Health Economics, Hospital Utilization, Sustainable Development, Strategic PurchasingAbstract
The Indonesian National Health Insurance (JKN) program is one of the largest public health financing schemes in the world, aiming to ensure equitable access to health services while maintaining fiscal sustainability. Hospital utilisation, particularly outpatient and inpatient care, significantly impacts the program’s financing and long-term sustainability. This study analyses enabling factors, such as hospital availability, referral patterns, and INA-CBG claim rates, and their economic implications for the sustainability of JKN. Using BPJS Kesehatan claim data from 2016–2019, we conducted bivariate analysis to assess correlations between enabling factors and hospital visit rates. Results show that higher INA-CBG rates, more hospital availability, and higher referral proportions are positively correlated with utilisation, thereby increasing health expenditures. From an economic perspective, these findings highlight the tension between access and sustainability, where expanding utilisation without adequate cost containment may jeopardise fiscal stability. The study concludes that strategic purchasing, equitable hospital distribution, and optimised referral mechanisms are critical economic strategies for ensuring the sustainability of JKN as part of Indonesia’s contribution to sustainable development.
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