Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms in Kabupaten Purbalingga, Central Java : A Case Study

Purbalingga is the first kabupaten in Indonesia to start implementing its health insurance scheme for the poor, as a replacement for the JPS-BK scheme (Social Safety Net Program Health Sector). Poor families (Gakin) receive a range of health insurance services that are subsidized by the government free-of-charge, while better-off families pay a premium of only 50% or 100%. They are categorized as participants in Gakin Levels I, II and III. The aim is to achieve universal coverage for all citizens in Kabupaten Purbalingga, those who are poor as well as those who are not. Kabupaten Purbalingga is considered unique in the scope of its health services, because it not only includes poor families in its scheme, but also non-poor families. The local government of Kabupaten Purbalingga considers the health insurance scheme to be one of the main pillars of the poverty reduction effort in the region. They want the management of this scheme to become more independent and less dependent on DinKes (the local government health agency) so the program can be managed more efficiently and with more accountability. What is rather interesting is that DinKes plans to arrange a health insurance scheme that will be autonomous and sustainable for all better-off members in the future. They intend to slowly increase the premium until it reaches the real cost of the assistance package. According to DinKes, the cost should be approximately Rp92,000 per family per month. From the perspective of Bapel, an autonomous scheme with that level of premium definitely has potential, however they will always depend on the premiums to be paid by the government. It needs to be noted that the Community Health Insurance Scheme (JPKM) initiative in Kabupaten Purbalingga is almost entirely the initiative of the government as its moving force. The main protagonists are government (Regent, DinKes and Bapel), public service providers (public hospitals and puskesmas), the local parliament (DPRD) and other government agencies.