Making Services Work for the Poor in Indonesia : A Report on Health Financing Mechanisms (JPK-Gakin) Scheme in Kabupaten Purbalingga, East Sumba, and Tabanan

The government of Indonesia has started the implementation of locally based healthfinancing schemes based on health insurance principles. This scheme is commonly known as JPK-GAKIN, which is a health-financing scheme through which the poor can access health care in public facilities, including primary and secondary health care. Due to the perceived success of JPK-GAKIN pilots, the government has decided to provide JPK-GAKIN in all districts in Indonesia from January 1, 2005. This study looks at the effects of different characteristics of JPK-GAKIN program on healthcare service provision, utilization of health care services, quality of healthcare provision, and how insurance characteristics can influence the relationships between stakeholders. Three districts were selected for the case studies : Purbalingga (Central Java), Tabanan (Bali) and East Sumba (Nusa Tenggara Timur). We found that compared with previous health financing schemes, JPK-GAKIN scheme has achieved better results in providing access to adequate health care coverage to members of the population, especially the poor. However, we found several problems associated with the scheme, such as : there is a need to improve its targeting and efficiency, it needs stricter financial monitoring and auditing, and it needs to increase stakeholders involvement in the governance of the scheme. We will elaborate on these concerns and recommend possible policy options to resolve them in this paper.