Optimasi Anggaran UHC JKN melalui Kebijakan Mapping Kepesertaan
DOI:
https://doi.org/10.59680/ventilator.v4i2.2455Keywords:
Budget Efficiency, Membership Mapping, PBI-Regional, PBPU, Universal Health CoverageAbstract
Universal Health Coverage (UHC) through Indonesia’s National Health Insurance (JKN) program aims to ensure equitable access to quality healthcare without causing financial hardship. In Bangkalan Regency, the PBPU and Local Government Contribution (BP Pemda/PBI D) segment represented around 19% of JKN participants in 2024. However, the rapid increase in membership was not supported by adequate regional budget capacity for premium payments. This study analyzed how participant mapping policies through verification and validation processes could improve budget efficiency and support the sustainability of the UHC JKN program. A descriptive qualitative approach was applied using purposive sampling involving 10 heads of primary health centers (puskesmas) and one informant from the Population and Civil Registration Office. Data were collected through questionnaires and document reviews related to JKN membership and health financing regulations, then analyzed thematically. The number of PBPU and BP Pemda participants increased from 108,779 in January to 130,097 in July 2024, while the allocated budget ceiling decreased compared to 2023. Key challenges identified included invalid participant data, weak implementation of local JKN regulations, moral hazard among financially capable residents shifting to subsidized schemes, and limited monitoring mechanisms. The study found that membership mapping through systematic verification and validation could improve targeting accuracy, reduce inefficient premium payments, and strengthen budget sustainability. Strengthened local regulations, intersectoral coordination, and funding support from DBHPR, DBHCHT, and earmarked DAU are crucial for effective implementation.
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