Local governments initially started carrying health insurance back in 2003 when Megawati Soekarnoputri’s government presented the Health Service Insurance for Poor Families program, or JPK-Gakin. The notion was for district managements to apply their personal community health insurance schemes in line with local requirements. Nevertheless, limited programs ever actually got off the ground before Susilo Bambang Yudhoyono’s new government presented a bill that laid the foundation for a nation-wide program and made JPK-Gakin redundant, Law no. 40/2004 on a National Social Security System (SJSN). Simultaneously, Yudhoyono’s government announced a program to run free, however basic, healthcare to the poor – Askeskin (health insurance for the poor), which was substituted in 2008 by Jamkesmas (community health insurance).
Certain regional administrations put up a round. In 2005, East Java’s government led a test at the Constitutional Court demanding that SJSN gave the central government a monopoly on social service provision and broke the constitution and Law no. 32/2004 on Regional Governance. The court approved that SJSN did not stop local governments from emerging their own social security programs, as well as for healthcare. Ever since, the quantity of local health insurance programs has increased year on year.
One of the groundbreaking systems was Jaminan Kesehatan Jembrana (JKJ) presented in 2003 by Gede Winasa, the head of Jembrana district in Bali. According to this scheme, all members of JKJ, may they be poor or non-poor get free primary care from public and private providers. Residents branded as poor acquire secondary and tertiary care too. Money comes chiefly from the district budget, with about central and provincial government subsidies. Winasa had preceding experience in the health sector, equally as a dentist and as a health bureaucrat, and he was extensively acclaimed for his idea and actual leadership by the media. It appears that several politicians round the country saw at the good promotional he received, and his fame with voters, and free healthcare schemes arose to spread.
Many Jamkesda programs bid simple care at community health centres (puskesmas), and typically just for the poor who aren’t covered by other programs, resembling the national scheme Jamkesmas. And reviews propose that because of the above reasons, scams and frauds sprout. But in resource-rich regions such as Aceh, healthcare programs are far more openhanded. In 2009 Aceh’s then Governor, Irwandi Yusuf, presented the Jaminan Kesehatan Aceh program. Similar to the scheme in Jembrana, JKA bids universal coverage for all residents of Aceh, and it began a dramatic point in the acceptance of health services with the consequence that some local hospitals have writhed to manage ever since.
JKA likewise covers almost all illnesses and patients with complex illnesses can be flown to hospitals in Jakarta to have treatment. Prices are so far about Rp. 400 billion (US$41 million) per year. Officials on the border of Aceh report that people go over from North Sumatra to get Aceh identity cards that will let them have free healthcare. The money for JKA comes from ‘special autonomy funds’ compensated by the central government as a consequence of the 2005 peace deal that ended the separatist insurgency in Aceh.
At the same time in the poorer regions of Indonesia, local administrations sense bound to bid some kind of free or heavily subsidized health service. The government introduced an insurance program that offered free basic care at public hospitals to residents not covered by alternative schemes, like Jamkesmasinn Kupang, the capital city of one of Indonesia’s poorest provinces, East Nusa Tenggara. While in Central Lombok, instead of providing basic healthcare coverage, the district head assured a much contracted program that covered free maternal health services to pregnant women.