Optimizing National Health Insurance (JKN) Policy to Support Sustainable Health Development in Gianyar Regency, Bali, Indonesia
DOI:
https://doi.org/10.59890/ijsr.v3i2.505Keywords:
JKN Implementation, Sustainable Health Development, Policy Adaptation, Maternal and Infant Mortality, Universal Health CoverageAbstract
The National Health Insurance (JKN) program is a key national strategy for achieving the Sustainable Development Goals (SDGs), particularly Goal 3, which focuses on good health and well-being. This study examines the implementation of JKN in Gianyar Regency, Bali, and its effectiveness in reducing the maternal mortality rate (MMR) and infant mortality rate (IMR), which are critical indicators of sustainable health development. Using a qualitative case study approach grounded in Van Meter and Van Horn's policy implementation model, data were collected through in-depth interviews, participatory observation, and document analysis with triangulation for validation. The results indicate that although Gianyar has achieved a high Universal Health Coverage (UHC) rate of 96.41%, the program's effectiveness is constrained by limited fiscal capacity, uneven distribution of the healthcare workforce, inadequate infrastructure, and low public health literacy. This study contributes to the policy discourse by emphasizing the importance of local contextual adaptation, including community-based strategies and digital integration (e.g., e-Kohort KIA), to optimize the implementation of JKN. The findings underscore the importance of multi-actor policy coordination and context-sensitive health financing innovations in supporting sustainable health outcomes at the subnational level.
References
Arnindiah, H., & Safriantini, N. (2019). Implementation of JKN and UHC Challenges in Indonesia. Journal of Public Policy, 12(1), 45–56.
Bappenas. (2022). National Action Plan for the Acceleration of Stunting Reduction 2021–2024. Jakarta: Ministry of National Development Planning/Bappenas.
Bappenas. (2022). Bali Province SDGs Regional Action Plan 2020–2024. Jakarta: Ministry of National Development Planning/Bappenas.
Birkland, T. A. (2019). An Introduction to the Policy Process: Theories, Concepts, and Models of Public Policy Making (4th ed.). Routledge.
BPJS Kesehatan. (2023). BPJS Kesehatan Performance Report in 2023. Jakarta: BPJS Kesehatan of the Republic of Indonesia.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Bredenkamp, C., Evans, T., & Lagrada, L. (2015). Emerging challenges in implementing Universal Health Coverage in Asia. World Bank Working Paper Series, 34(2), 21–34.
Creswell, J. W., & Poth, C. N. (2018). Qualitative Inquiry and Research Design: Choosing Among Five Approaches (4th ed.). SAGE Publications.
Gianyar Regency Health Office. (2023). Health Profile of Gianyar Regency in 2023. Gianyar: Gianyar Health Office.
Herawati, C., & Bakhri, S. (2019). Ketimpangan Pelayanan Kesehatan Dasar dan Ekonomi di Wilayah Perbatasan. Afiasi: Jurnal Kesehatan Masyarakat, 4(1).
Ministry of Health of the Republic of Indonesia. (2020). National Health System (SKN): Book I – Conceptual Framework of SKN Revision 2020. Jakarta: Ministry of Health of the Republic of Indonesia.
Ministry of Health of the Republic of Indonesia. (2020). JKN Program Evaluation Report for 2019–2020. Jakarta: Ministry of Health of the Republic of Indonesia.
Ministry of Finance of the Republic of Indonesia. (2022). Financial Memorandum and State Budget for Fiscal Year 2023. Jakarta: Ministry of Finance of the Republic of Indonesia.
Madani, J. F., Arianto, G., & Widiyanto, T. (2022). Analysis of Factors Affecting AKI and AKB in Indonesia. Journal of Health Epidemiology, 10(2), 101–115.
Novita, Y., & Hafidz, M. (2020). Gap in Access to National Health Insurance in the Regions. Journal of Indonesian Health Administration, 8(3), 137–150.
Patton, M. Q. (2002). Qualitative Research and Evaluation Methods (3rd ed.). Thousand Oaks, CA: Sage Publications.
Pisani, E., Kok, M., & Nugroho, K. (2017). Indonesia's road to universal health coverage: A political journey. Health Policy and Planning, 32(2), 267–276.
Pradnyani, S. M., Putra, A. D., & Dwijendra, N. K. A. (2024). Digitization of Maternal and Child Health Services in Bali. Journal of Digital Health Technology, 6(1), 44–56.
Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2020). Challenges in maternal and neonatal health services in decentralized Indonesia: Evidence from health system review. BMC Health Services Research, 20(1), 1–12.
United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. United Nations.
Van Meter, D. S., & Van Horn, C. E. (1975). The policy implementation process: A conceptual framework. Administration & Society, 6(4), 445–488.
WHO. (2023). World Health Statistics 2023: Monitoring Health for the SDGs. Geneva: World Health Organization.
Yulianti, E., & Madani, J. F. (2021). Health Literacy in Rural Communities: A Case Study of Central Bali. Indonesian Journal of Health Promotion, 9(2), 55–67.
