Table 1.
Main features of the three health insurance schemes in Indonesia.
| Characteristics | Health Insurance Schemes | ||
|---|---|---|---|
| Askes | Jamsostek | Askeskin | |
| Established | 1968 | 1992 | 2005 |
| Population coverage | 14 million (about 6% of the population) in 2007 | 4.1 million (about 2% of the population) in 2009 | 76.4 million (about 34% of the population) in 2007 |
| Participation | Mandatory | Mandatory, opt-out option for employers that could provide better benefit plans | Social insurance |
| Organization/Carrier | State-owned company (PT ASKES Indonesia) | State-owned company (PT JAMSOSTEK Indonesia) | Ministry of Health |
| Beneficiaries | Civil servants, pensioners of civil servants and armed forces | Formal private employee | Identified poor and near poor, based on individual and household targeting |
| Eligible dependents | Spouse and 2 oldest children <21 years of age (if unemployed, unmarried), or <25 years of age if a full-time student | Spouse and 3 oldest children <21 years of age | Spouse and children |
| Source of funds | Member contribution 2% of basic salary + contribution from government 2% of basic salary | Member contribution, if single: 3% of basic salary; member with dependents: 6% of basic salary | No contribution from beneficiaries because it is tax-based with calculation for premium 6,000 IDR (0.46€) per capita |
| Benefits package and provider choice | Outpatient and inpatient care at public providers only | Outpatient care at both public and private providers networks, and for inpatient care at public providers only | Outpatient and inpatient care at public providers only |
| Negative list of benefits package | Cosmetic surgery, physical check-up, alternative medicine, dental prostheses, fertility treatment, non-basic immunization | General check-up, cancer treatment, heart surgery, renal dialysis, and lifelong treatment for congenital diseases, prostheses, non-basic immunization, transplantation, fertility treatment | Cosmetic surgery, physical check-ups, alternative medicine, dental prostheses, fertility treatment |
| Copayment | Yes, if members want to upgrade class, branded drugs out of formulary, renal dialysis, transplantation, heart surgery | None, but Jamsostek does not cover high cost treatments such as cancer treatment, heart surgery, and renal dialysis | None |
| Provider payment arrangement | Primary care: capitation Secondary care: fee schedule | Primary care: capitation Secondary care: capitation and fee schedule | Primary care: capitation Secondary care: negotiated fee with limit |