10 February 2023
In Indonesia, participation of young children from the fully subsidised members of the National Health Insurance (PBI-JK) segment is relatively low. This can affect the increasing mortality rate in children due to lack of health protection. It is crucial that all relevant stakeholders are involved in the effort to promote the importance of health insurance in Indonesia through JKN. The JKN program can prevent Indonesian young generation from becoming vulnerable and falling into poverty.
Based on the Indonesia Health Profile 2021, death rate of children under 5-year-old in Indonesia is up to 28,158 deaths. Neonatal death is the largest proportion, with 71.97 percent of total death or equals to 20,266 children died within the range of 0-28-day old. While 19.13 percent or 5,386 died within the range of 29-day old to 11-month-old, and 8.9 percent or equals to 2,506 children died within the range of 12-59-months old. Most common causes of death are congenital anomalies, infection, diarrhea, and pneumonia.
On January 2021 the Social Security Agency for Health (BPJS Kesehatan) and based on the calculation of National Socio-Economy Survey (Susenas) on March 2021, the participation of Indonesian children under 5-year-old in the Fully Subsidised Health Insurance (PBI-JK) is still low. Participant from age group 0–4-year-old is only 27.26 percent of total number PBI-JK participants. This is the lowest among other age groups. In addition, although the participation of households with children under 5-year-old in JKN has reached 70.8 percent, only 14.1 percent of household with children under 5-year-old enrolled in JKN. It means that not all their children have been registered as PBI-JK participants.
Similar with the nationwide condition, data on the three districts, Cianjur (West Java), Banyuwangi (East Java), and Manggarai (West Nusa Tenggara) showed participation of children under five in the JKN is very low.
The low number of children in the household participating in JKN is caused by, among others, 29 percent of health workers do not understand the process for registering newborn (NB) for health insurance. Another factor is due to the inefficiency in collecting NB data. For example, claim for hospital bill for birth is trough V-Claim application, while the newborn data collection is done through SIPP app (Complaint Management Information Channel). Therefore, health workers must entry the data twice.
The study found that all respondents from health facilities, such as puskesmas (community public health center) and health clinics, admitted that there are many children in the PBI-JK segment that do not own the Healthy Indonesia Card (Kartu Indonesia Sehat/KIS), so that patients used paid general services, or they obtained certain policy as poor patients. New patients will arrange their own participation in the Health Insurance program only when dealing with serious health problems with high cost. These findings prove that there is minimum knowledge on the importance of health insurance from the preventive aspect.
Local Area Practices
The reasons why respondent or informant who do not register their children to participate in PBI-JK, are as follows: (1) respondents’ limited information, (2) the respondent has not processed baby’s citizenship document yet; (3) respondent has limited finances, time, and access to transportation; (4) in the first three months, parents are still occupied with looking after the baby, so the three-month time limit for registration is too short; (5) respondent delay the registration as they deem it as unnecessary.
How about the practice in the local areas? In the Manggarai District, respondents are unable to meet the requirements to obtain birth certificate or Resident Identification Number (NIK) due to the high cost for marriage. There are also cost for child’s baptism, or other requirements to arrange a birth certificate or NIK, just like marriage certificate or baptism certificate.
Meanwhile, Banyuwangi District has initiated programs in making the public service easier through, among others, proactive services, administration service during weekend, and one-day service, because the process is only in one place.
In general, PBI-JK in those three districts are well-regulated. However, the registration process is complicated and put much burden on the officers, causing potential human-error. PBI-JK participation scope is relatively low because mothers and families participated in PBI-JK has limited knowledge related to children participation. Other factor is because health workers do not include the registration of newborn for the PBI-JK in their socialization. It is important to continue promoting the simplicity in population documentation process.
Several key stakeholders, such as Ministry of Social Affairs (MoSA), Ministry of Health (MoH), Social Security Agency for Health (BPJS Kesehatan), and Population and Civil Registry Services (Disdukcapil) at the local level, and existing health facilities can help improve the situation. While stakeholders that can contribute to coverage improvement are Coordinating Ministry for Human Development and Cultural Affairs/Kemenko PMK, BAPPENAS, and BKKBN.
Apart from that, it is still necessary to strengthen support for the system such as training for family development session (FDS) to the Indonesian Conditional Cash Transfer Program (PKH) supervisor especially related to new-born PBI-JK data collection, capacity building for Posyandu cadres related to participation in National Health Insurance, especially for babies of mothers participating in PBI-JK.
When all those requirements are met, mortality rate of young children in Indonesia may be reduced and Indonesia will have strong and healthy future generations.