Holistic Evaluation of the National Health Insurance Program in the Local Context of Indonesia


This article reviews the evaluation of the National Health Insurance policy, exploring various aspects such as effectiveness, efficiency, adequacy, leveling, responsiveness, and accuracy in its implementation. Researchers use the case study method with a qualitative approach to describe and analyze phenomena, events, attitudes, social activities, and perceptions of individuals and groups related to the National Health Insurance program. This study analyses the effectiveness, efficiency, adequacy, leveling, responsiveness, and accuracy of National Health Insurance program policies in a region. The results showed that 1) The effectiveness of the National Health Insurance policy is still not optimal due to the lack of employee commitment in implementing the work agreement mechanism between the Regional Government and BPJS Kesehatan Boroko Branch. 2) In terms of efficiency, the implementation of standard operating procedures has shown optimality, but there are still obstacles related to administrative requirements for eligible prospective National Health Insurance policy participants. 3) The adequacy of the National Health Insurance policies have not been effective due to an increase in new participants, that is, not balanced with the available budget, resulting in delays in service claims for health workers. 4) The leveling of the National Health Insurance policy has not been effective due to constraints in recipient data, which resulted in a reduction in the quota from BPJS Kesehatan, leaving deserving community groups without assistance. 5) The responsiveness of this policy is disrupted by the validation of the criteria for recipients of contribution assistance which is not synchronized with the regional budget and the lack of direct data submission when applicants submit a poor statement letter at the village level. 6) The accuracy of this policy is still limited by the limitations of the regional budget in reaching all communities covered by this program in North Bolaang Mongondow Regency.

Keywords: policy, evaluation, national health insurance

[1] Teerawattananon Y, Russell S. A difficult balancing act: policy actors’ perspectives on using economic evaluation to inform health-care coverage decisions under the Universal Health Insurance Coverage scheme in Thailand. Value Health. 2008 Mar;11(1 Suppl 1):S52–60.

[2] Kim WJ, Shin YJ. Evaluation of The Efectivenesss of The Policy to Expand the Scope of National Health Insurance dental scaling service benefits. J Korean Acad Oral Health. 2022;46(4):192–206.

[3] Agboola OC, Usman OA. Evaluation of The Public Health Financing and National Health Insurance Scheme Policy in Nigeria. Journal of Applied Mathematics and Statistical Analysis. 2020;1(2):1–7.

[4] Kumar A, et al. Effect of Public Funded Health insurances in financial protection for hospitalisation in Rajasthan state india: evidence from a national sample survey. Volume 24. Clinical Epidemiology and Global Health; 2023.

[5] Aboagye DC, South J, Khan HT. Evaluation of community perspectives on national health insurance policy to health service delivery in Ghana. Illn Crises Loss. 2021;29(1):3–18.

[6] Liu K, Liu W, He AJ. Evaluating health policies with subnational disparities: a textmining analysis of the Urban Employee Basic Medical Insurance Scheme in China. Health Policy Plan. 2023 Jan;38(1):83–96.

[7] Fadillah F. Evaluasi Implementasi Program Jaminan Kesehatan Nasional di Puskesmas Sei Baung Palembang. Skripsi. 2021;10(3):1–9.

[8] Nurrizka RH. Jurnal Kebijakan Kesehatan Indonesia. JKKI. 2019;8(1):35–40.

[9] Insani VR, Nurdan JH. Evaluasi Tata Kelola Jaminan Kesehatan Nasional dalam Penguat Peran Pemerintah Daerah Bengkulu. Human Care Journal. 2022;7(1):146– 52.

[10] Anggriani Y, Rosdiana R, Khairani S. Evaluasi Perencanaan dan Pengadaan Obat di Era Jaminan Kesehatan Nasional di Puskesman Kabupaten Cianjur. PHARMACY: Jurnal Farmasi Indonesia. 2020;17(2):425.

[11] Sugiyono PD. Metode Penelitian Bisnis: Pendekatan Kuantitatif, Kualitatif, Kombinasi, dan R&D. Bandung: Penerbit CV Alfabeta; 2017.

[12] Al Hudib H, Cousins JB. Understanding Evaluation Policy and Organizational Capacity for Evaluation: An Interview Study. Am J Eval. 2022;43(2):234–54.

[13] O’Neill S, Kreif N, Sutton M, Grieve R. “A Comparison of methods for health policy evaluation wirh controlled pre-post designs,”. Health Serv Res. 2020;55(2):328–38.

[14] Chelimsky E. Integrationg Evaluation Units into the political environment of goverment: the role of evaluation policy. Evaluation Policy and Evaluatin Practice. 2009;123:51–66.

[15] Datta L. Golden is the sand: memory and hope in evaluation policy and evaluation practice. New Dir Eval. 2009;123(123):33–50.

[16] Mark, et al. “Evaluation Policy an Introduction and overview,” Evaluation policy and evaluation practice, vol. 123, pp. 3-11, 2009. https://doi.org/10.1002/ev.302.

[17] Putrianti SD, Wahyudi B. “Evaluasi kebijakan jaminan kesehatan masyarakat di Rumah Sakit Umum Daerah Dr. Rubini Kabupaten Pontianak,” Jurnal Ilmu Administrasi Media Pengembangan Ilmu dan Praktek Administrasi, vol. 12, no. 2, pp. 189-208, 2015.

[18] Salsabila N, Hadi P, Syarif SH, Istanti ND. Evaluasi Kebijakan Pembiayaan Kesehatan bagi masyarakat miskin pada program jaminan kesehatan nasional. Usada Nusantara: Jurnal Kesehatan Tradisional. 2023;1(2):51–64.

[19] Agustanti, Anita A, Purwati P, Kodri K. Jaminan kesehatan Nasional dan kepuasan layanan kesehatan reproduksi National Health Insurance and Reproductive Health Service Satification. Jurnal Keperawatan Raflesia. 2022;4(1):11–20.