Understanding Indonesia’s Healthcare System for Expats and Foreigners
Indonesia’s public healthcare system is undergoing significant changes. While it is currently ranked 92nd by the World Health Organization, Indonesia’s facilities are gradually improving.
Additionally, the government is committed to enhancing its investment in health services. And while there have been some obstacles along the way, Indonesia’s healthcare system is poised to become the largest universal healthcare provider in the world.
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Overview of Healthcare in Indonesia
Indonesia’s healthcare system is well on the road to achieving universal healthcare. In 2014, the country launched a mandatory health insurance program called Jaminan Kesehatan Nasional (JKN). It’s designed to make basic medical care and facilities available to all citizens. It was implemented by the Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) social security agency.
Before this, an estimated 56% of Indonesians (as of 2010) had some form of health insurance. However, it was far from a unified system. Those insured were a mix of state employees, well-to-do citizens with private coverage, and low-income citizens who pre-qualified for state programs.
Charitable organizations filled many of the gaps in providing care for the vulnerable. One of the goals of JKN was to make sure that those in the middle—too poor for insurance but too well off for relief programs—weren’t forgotten.
Under JKN, the government aimed to achieve 100% coverage nationwide by 2019. However, progress has been slow. One of the most significant problems is the lack of participation by hospitals and clinics. Not all facilities have opted to join the JKN program, resulting in patients facing substantial gaps in care.
This, in turn, puts additional stress on the Puskesmas, Indonesia’s community health clinics. Additionally, critics allege that JKN isn’t well-managed. They say that leaders underestimated the challenge of reaching remote areas and taking over the extensive services once offered by charities.
It didn’t help that communication was poor during the initial rollout phase. For instance, those who were already receiving government-sponsored healthcare for the poor didn’t need to enroll in the JKN program formally.
Alas, no one thought to tell many of those patients. As such, they dutifully visited clinics for an enrollment program they didn’t need.
How Puskesmas Works in Indonesia
There are more than 9,700 Puskesmas across Indonesia. Overseen by the Ministry of Health, they are responsible for providing healthcare at the sub-district level. There are two kinds of Puskesmas, those with beds and those without. However, the differences add up to much more than accommodation availability.
Puskesmas without beds operate as a daytime-only clinic. They can treat public outpatient concerns and implement different public health programs. Patients visit Puskesmas without beds for non-urgent, prevention-focused care. This includes antenatal appointments and family program services.
Usually staffed by a general practitioner and a bidan (nurse), these Puskesmas are often stretched to the limit, despite not being responsible for critical care.
As such, if a seriously ill patient comes to a Puskesma without beds, they’ll likely be sent to the next facility without even the benefit of a cursory examination or stabilizing care.
Puskesmas with beds are usually located in rural areas. They operate as a de facto 24-hour emergency center—even though their ability to cope with emergencies is limited. One of their primary responsibilities is to provide BEOC/PONED (Basic Emergency Obstetric Care and Newborn Emergency Care).
Unfortunately, those staffing the Puskesmas with beds aren’t always trained in BEOC/PONED care. UNICEF-funded training is slowly turning this around by providing resources for specialized education.
Costs of the Healthcare System
Under the JKN program, Indonesians receive coverage from public healthcare providers and private facilities that opt to join the system. Individuals who hold traditional employment will pay an insurance premium equivalent to 5% of their salary. The employee pays 1%, and the employer pays 4%.
Those who are self-employed or informal workers pay a fixed monthly premium, which can be as low as $2 per month. For better or worse, the number of people who are employed informally is relatively high.
As such, they have no employer to advocate on their behalf and often cannot afford the premiums independently. Thus, even with a new system in place, people are still at risk of slipping through the cracks.
The Differences Between Private and Public Care
For the most part, public health facilities in Indonesia are modest in nature. Major cities like Jakarta have access to good public hospitals, but rural clinics often offer minimal resources. Additionally, most public facilities are in dire need of investment for modern equipment, laboratory services, and staffing capabilities.
Private facilities, in contrast, are clean, well-organized, and up-to-date. A much higher percentage of the staff speak English compared to public centers. Additionally, wait times are significantly shorter, and a wide range of specialists is available. Patients can expect to receive care in a comfortable, private environment.
Who is Eligible for Health Coverage in Indonesia
All expats employed in Indonesia are required to join the JKN program. After you’ve been working in the country for at least six months, your employer will take care of the details.
Upon registration, you and all your family members will receive the public health insurance cards that you must present at every medical appointment.
Healthcare Options for Expats and Foreigners
Even after joining the JKN program, most expats opt to carry private international health insurance. The majority of Indonesian public health facilities do not meet the standards that most expats are familiar with.
Private insurance offers the best chance of being treated by English-speaking staff and provides more comfortable and convenient treatment options.
Best Global Health Insurance Options in Indonesia
Cigna Global Insurance Plan
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William Russell Health Insurance
- Worldwide coverage with access to private hospitals and trusted medical networks.
- Comprehensive benefits, covering inpatient care, outpatient treatment, mental health, and emergency evacuation.
- Flexible plan levels that let expats choose the coverage and budget that fit their lifestyle.
Health Insurance for US Citizens Living in Indonesia
BCBS Global Solutions Worldwide Premier
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- For U.S. citizens abroad or foreign nationals in the U.S.
Mental Healthcare in Indonesia
An estimated 11% of the Indonesian population suffers from a mental health disorder. The actual number may be much higher. However, less than 1% of the country’s healthcare budget is dedicated to mental health services.
Also, out-of-date legislation is written from the perspective that those with mental illness are dangerous to the community, further stigmatizing the situation. Finally, the practice of pasung, using physical restraints to tie down the mentally ill, is sadly still common.
Resources on the ground are thin. There’s only one mental health hospital per every 5 million people. Nearly all psychiatrists are located in urban centers. Virtually none work in rural areas. Alas, these are often the very people who need mental health support the most.
Many Indonesian communities remain deeply traumatized by the lasting effects of the 2004 tsunami, which killed an estimated 250,000 people and displaced approximately 500,000 more.
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Joe Cronin, President of ICI, is a leading expert in international health, life, and travel insurance. An MBA and founder of multiple global businesses, he helps expatriates and travelers access trusted, comprehensive insurance solutions worldwide.
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