JAKARTA, Indonesia — Indonesia is the fourth most populous country in the world, comprising of more than 17,000 islands. Healthcare in Indonesia is a complex subject of debate. In 2014, the Indonesian government implemented Jaminan Kesehatan Nasional (JKN), a health insurance system that aims to provide healthcare to every citizen in the country. A significant wealth gap divides Indonesians living in rural areas and those in well-developed, urban environments and health services also vary significantly between regions. JKN is only beginning to close that gap.
Insurance and Growth
JKN covers more than 80% of the Indonesian population but it intends to reach the entire population in the near future. JKN is currently one of the largest single-payer systems in the world. Though some observers doubt the system, it has provided hundreds of millions of Indonesians with access to health insurance.
There are now approximately 2,000 hospitals in the country, half privately-owned and half publicly-owned. As a result of JKN, more local Indonesian companies began providing and manufacturing medical equipment for hospitals — shifting from heavy reliance on imported medical resources. This meant new jobs and financial opportunities for local residents, which further benefited their communities.
Indonesia’s Wealth Gap
Slightly more than half of Indonesia’s population lives in urban areas, and the numbers are increasing. A study in 2000 indicated that 14.6% of Indonesians in urban areas live in poverty in comparison to 22.4% in rural areas. There is a large divide between the lifestyles of rural and urban Indonesians, and the country is still sixth in the world for the worst distributed wealth among its population.
According to studies, JKN has not been successful in minimizing the wealth gap between the country’s richer and poorer populations because people have limited access to healthcare in rural areas. Urban women are three times more likely to have an in-hospital birth than rural women, and rich women are about five times more likely to give birth in a safe, clean facility. Other studies reveal that economically subsidized and uneducated individuals are less likely to be eligible for healthcare in Indonesia. Moreover, 75.6% of rural households include members who lack a complete education and cannot fully understand the healthcare system. This further exacerbates the divide between urban and rural residents’ access to medical resources.
Traditionally, Indonesians hold a mix of beliefs regarding the outcome of a child’s birth, including the idea that “little can be done to save the life of a pregnant woman or newborn.” Partly because of JKN, Indonesians now understand the medical benefits of maternal and neonatal care, and infant mortality rates have dropped from what was 41.1 deaths per 1,000 births in 2000 to 21.1 per 1,000 in 2018.
Poorer women in Indonesia still experience disadvantages because the system does not prioritize hospitals in low-income villages. JKN is improving maternal care because insured women now have unlimited access to neonatal health services, antenatal and postnatal care, postpartum care, cesarean section deliveries and more. Before JKN, antenatal and postnatal care services limited women to four visits. However, the system still disproportionately benefits women in higher-income areas. With limited resources and funds in rural areas, more women use midwives for a home birth, whereas women in cities typically rely on doctors.
Malaria and COVID-19
Indonesia is arguably one of the most beautiful countries in the world, but its proximity to the equator allows parasites to thrive in warm conditions. There are hundreds of thousands of infections of malaria in Indonesia, leading to almost 2,000 deaths every year. The CDC has worked to raise awareness and reduce infections in Indonesia’s vulnerable regions, making progress in all areas except Papua Province. Papua Province’s residents account for 74% of malaria cases.
Since the outbreak of COVID-19, Indonesia has reported over 100,000 cases as of July 29, 2020. Indonesia strictly enforced social distancing and closures in April 2020, and as of June 10, 2020, 287,478 people obtained tests. A test at a private hospital in Indonesia varies from $142 to $178, making it difficult for many citizens to afford it.
Healthcare in Indonesia is progressively growing and expanding, but the system currently fails to address the wealth gap between those in rural and urban areas. Especially as the COVID-19 pandemic continues, JKN and Indonesia’s other healthcare initiatives will be crucial to maintaining a healthy population.
– Josie Collier