In 2014, the national social health insurance scheme Jaminan Kesehatan Nasional (JKN) was established in Indonesia based on the Law No.40/2004 on the National Social Security System. This required the integration of the various public health insurance schemes existing at that time into a single insurance system. The new health insurance programm aims to cover Indonesians (Universal Health Coverage).
Formal employees are registered in JKN by their employers, while the contributions of poor people are subsidized by the government. Informal workers must register themselves in JKN. JKN is managed by the Social Security Administering Body for Health (BPJS-K). This agency contracts and pays both public and private providers across the country, though the purchasing policies are set by the Ministry of Health.
Within less than 10 years, JKN has been expanded to insure almost 90% of the population, significantly reducing out of pocket expenditures for health care.
German Development Cooperation has supported the Indonesian government throughout the reform efforts since more than 20 years, especially with the preparation and launch of the JKN program as well as the establishment of the implementing agency BPJS-K.
Following this reform, innovative approaches to complement the existing social protection system, in particular social assistance for vulnerable people and those in poverty were developed under the Indonesian-German cooperation, with a special focus on financial inclusion, inclusion of disabled persons, employment promotion and adaptive social protection in support of a broader social protection reform (Innovative approaches for Indonesia’s social protection reform - giz.de).
Since 2023, integrated solutions for disaster risk management and social protection are under development as well: Advancing Adaptive Social Protection in Indonesia - giz.de
Since the JKN's establishment in 2014, Indonesia's health insurance has established itself as the largest contribution-based health insurance in the world. JKN coverage more than doubled, increasing from 133.4 million people in 2014 to 280 million in July 2025, reaching nearly 98% of Indonesia’s population.
In July 2023, the Indonesian ministry of health announced that the expenditure used to cover the contributions of the poor to the JKN program amounted to 46,3 trillion IDR (around 3 billion USD). In 2021, a World Bank report estimated that the total government financing of the scheme between 2014 and 2021 amounted to 41 billion USD. (Worldbank ESSA National-Health-Insurance-JKN-Reforms-and-Results-Program )
The creation of the Social Security Implementing Agency (SSIA) on Health was one of the mandates of National Social Security Act (NSSA) in 2004. Preceding the inception of the SSIA on Health, Indonesia had at least three separate health insurance management entities. These fragmented health insurance schemes underwent a substantial consolidation, and were merged fundamentally into a single public entity known as BPJS (SSIA) in 2011. Different from its predecessors, the SSIA on Health is structured as a nonprofit institution, in compliance with the stipulations of the NSSA Law. There exist two distinct branches of SSIA: BPJS Kesehatan (for health insurance) and BPJS Ketenagakerjaan (for employment). The roadmap for establishing JKN in 2012 was launched as a joint effort by six ministries. Starting from 2014, the SSIA on Health commenced the implementation of the mandated JKN.
Satu Sehat, or “One Health,” is a health information exchange platform that serves as a core component to support the exchange of data among health facility information systems, both private and public, as well as other health data management information systems throughout Indonesia, creating a shared health record for all Indonesians. BPJS-K manages and oversees the overall Management Information System (MIS) for the JKN program, with relevant tasks and divisions of responsibilities under the coordination and oversight of the Directorate of Information Technology. While JKN is integrated into Satu Sehat, the scheme also utilizes an app (Mobile JKN). The app improves accessibility for participants while reducing administrative workload. Mobile JKN allows people to register, view billing information, pay monthly contributions, select or change the primary healthcare provider, and file complaints, all from their cellular devices.
How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia - PMC (nih.gov): The study shows, that JKN membership reduces the likeliness of households by 30 to 37 percent to incure any out-of-pocket payments for healthcare. This effect was especially pronounced among the poor and rural population, thereby reducing poverty and the risk of falling below the poverty line.
Further evidence / studies:
The Road to National Health Insurance (JKN).pdf
Trusted partners for Universal Health Coverage – Healthy DEvelopments (bmz.de)
The effectiveness of the reform efforts were built on a strong legal framework, and, amongst others, was able to draw on a longstanding cooperation and responsiveness of development cooperation partners to the needs at hand. German Development Cooperation contributed long standing technical expertise, grounded in experiential learnings. Financing local advisors helped to translate existing international expertise into the local context. They have facilitated change processes as respected conveners and subject matter experts and helped to design solutions that were technically sound and politically viable.
German development cooperation was able to act as a trusted convener, neutral broker and advocate for the common goal of UHC. This was made possible (a) by its approach of working with and through national staff and local champions, (b) because it was not seen to be pushing its own agenda, and (c) because it was not perceived as a ‘threatening’ actor with a big budget that would bend decisions in its preferred direction.
For further lessons see Trusted partners for Universal Health Coverage
Ministry of National Development Planning (BAPPENAS)National Disaster Management Authority (BNPB)
Directorate for Natural Resources and Regional Cooperation in BAPPENAS
Ministry of Finance sub-department, the National Fiscal Policy Agency (BKF)
Social Security Administration Organisation (BPJS)
Indonesian post service provider PT Pos
United Nations Environment, Humanity and Security (UNU-EHS)
Munich Climate Insurance Initiative (MCII)
MADIBA consult
WHO
World Bank Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
https://www.giz.de/en/worldwide/16688.html; BPJS Kesehatan
SDG 1 - No poverty
- Target 1.1 - By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day
- Indicator 1.1.1 - Proportion of the population living below the international poverty line by sex, age, employment status and geographical location (urban/rural)
- Target 1.3 - Implement nationally appropriate social protection systems and measures for all, and by 2030 achieve substantial coverage of the poor and the vulnerable
- Indicator 1.3.1 - Proportion of population covered by social protection floors/systems, by sex, distinguishing children, unemployed persons, older persons, persons with disabilities, pregnant women, newborns, work-injury victims and the poor and the vulnerable
SDG 3 – Good Health and Wellbeing
- Target 3.8 - Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
- Indicator 3.8.1 - Coverage of essential health services
SDG 10 - Reducing Inequalities
- Target 10.1 - By 2030, progressively achieve and sustain income growth of the bottom 40 per cent of the population at a rate higher than the national average
- Indicator 10.1.1 - Growth rates of household expenditure or income per capita among the bottom 40 per cent of the population and the total population
- Target 10.2 - By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status
- Indicator 10.2.1 - Proportion of people living below 50 per cent of median income, by sex, age and persons with disabilities
SDG 1 – No poverty
- Target 1.1 – By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day
- Indicator 1.1.1 – Proportion of the population living below the international poverty line by sex, age, employment status and geographical location (urban/rural)
- Target 1.3 – Implement nationally appropriate social protection systems and measures for all, and by 2030 achieve substantial coverage of the poor and the vulnerable
- Indicator 1.3.1 – Proportion of population covered by social protection floors/systems, by sex, distinguishing children, unemployed persons, older persons, persons with disabilities, pregnant women, newborns, work-injury victims and the poor and the vulnerable
SDG 3 – Good Health and Wellbeing
- Target 3.8 – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
- Indicator 3.8.1 – Coverage of essential health services
SDG 10 – Reducing Inequalities
- Target 10.1 – By 2030, progressively achieve and sustain income growth of the bottom 40 per cent of the population at a rate higher than the national average
- Indicator 10.1.1 – Growth rates of household expenditure or income per capita among the bottom 40 per cent of the population and the total population
- Target 10.2 – By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status
- Indicator 10.2.1 – Proportion of people living below 50 per cent of median income, by sex, age and persons with disabilities
In 2014, the national social health insurance scheme Jaminan Kesehatan Nasional (JKN) was established in Indonesia based on the Law No.40/2004 on the National Social Security System. This required the integration of the various public health insurance schemes existing at that time into a single insurance system. The new health insurance programm aims to cover Indonesians (Universal Health Coverage).
Formal employees are registered in JKN by their employers, while the contributions of poor people are subsidized by the government. Informal workers must register themselves in JKN. JKN is managed by the Social Security Administering Body for Health (BPJS-K). This agency contracts and pays both public and private providers across the country, though the purchasing policies are set by the Ministry of Health.
Within less than 10 years, JKN has been expanded to insure almost 90% of the population, significantly reducing out of pocket expenditures for health care.
German Development Cooperation has supported the Indonesian government throughout the reform efforts since more than 20 years, especially with the preparation and launch of the JKN program as well as the establishment of the implementing agency BPJS-K.
Following this reform, innovative approaches to complement the existing social protection system, in particular social assistance for vulnerable people and those in poverty were developed under the Indonesian-German cooperation, with a special focus on financial inclusion, inclusion of disabled persons, employment promotion and adaptive social protection in support of a broader social protection reform (Innovative approaches for Indonesia’s social protection reform – giz.de).
Since 2023, integrated solutions for disaster risk management and social protection are under development as well: Advancing Adaptive Social Protection in Indonesia – giz.de
The effectiveness of the reform efforts were built on a strong legal framework, and, amongst others, was able to draw on a longstanding cooperation and responsiveness of development cooperation partners to the needs at hand. German Development Cooperation contributed long standing technical expertise, grounded in experiential learnings. Financing local advisors helped to translate existing international expertise into the local context. They have facilitated change processes as respected conveners and subject matter experts and helped to design solutions that were technically sound and politically viable.
German development cooperation was able to act as a trusted convener, neutral broker and advocate for the common goal of UHC. This was made possible (a) by its approach of working with and through national staff and local champions, (b) because it was not seen to be pushing its own agenda, and (c) because it was not perceived as a ‘threatening’ actor with a big budget that would bend decisions in its preferred direction.
For further lessons see Trusted partners for Universal Health Coverage
Job placement/intermediation; Integrated programmes for climate and shock resilience, including programmes related to anticipatory, adaptive and shock-responsive social protection
Ministry of National Development Planning (BAPPENAS)National Disaster Management Authority (BNPB)
Directorate for Natural Resources and Regional Cooperation in BAPPENAS
Ministry of Finance sub-department, the National Fiscal Policy Agency (BKF)
Social Security Administration Organisation (BPJS)
Indonesian post service provider PT Pos
United Nations Environment, Humanity and Security (UNU-EHS)
Munich Climate Insurance Initiative (MCII)
MADIBA consult
WHO
World Bank Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
The creation of the Social Security Implementing Agency (SSIA) on Health was one of the mandates of National Social Security Act (NSSA) in 2004. Preceding the inception of the SSIA on Health, Indonesia had at least three separate health insurance management entities. These fragmented health insurance schemes underwent a substantial consolidation, and were merged fundamentally into a single public entity known as BPJS (SSIA) in 2011. Different from its predecessors, the SSIA on Health is structured as a nonprofit institution, in compliance with the stipulations of the NSSA Law. There exist two distinct branches of SSIA: BPJS Kesehatan (for health insurance) and BPJS Ketenagakerjaan (for employment). The roadmap for establishing JKN in 2012 was launched as a joint effort by six ministries. Starting from 2014, the SSIA on Health commenced the implementation of the mandated JKN.
Since the JKN’s establishment in 2014, Indonesia’s health insurance has established itself as the largest contribution-based health insurance in the world. JKN coverage more than doubled, increasing from 133.4 million people in 2014 to 280 million in July 2025, reaching nearly 98% of Indonesia’s population.
In July 2023, the Indonesian ministry of health announced that the expenditure used to cover the contributions of the poor to the JKN program amounted to 46,3 trillion IDR (around 3 billion USD). In 2021, a World Bank report estimated that the total government financing of the scheme between 2014 and 2021 amounted to 41 billion USD. (Worldbank ESSA National-Health-Insurance-JKN-Reforms-and-Results-Program )
Satu Sehat, or “One Health,” is a health information exchange platform that serves as a core component to support the exchange of data among health facility information systems, both private and public, as well as other health data management information systems throughout Indonesia, creating a shared health record for all Indonesians. BPJS-K manages and oversees the overall Management Information System (MIS) for the JKN program, with relevant tasks and divisions of responsibilities under the coordination and oversight of the Directorate of Information Technology. While JKN is integrated into Satu Sehat, the scheme also utilizes an app (Mobile JKN). The app improves accessibility for participants while reducing administrative workload. Mobile JKN allows people to register, view billing information, pay monthly contributions, select or change the primary healthcare provider, and file complaints, all from their cellular devices.
https://www.giz.de/en/worldwide/16688.html; BPJS Kesehatan