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All Journal Jurnal Administrasi Publik (JAP) Journal of Governance Publikauma : Jurnal Administrasi Publik Universitas Medan Area Otoritas : Jurnal Ilmu Pemerintahan Dinamika : Jurnal Ilmiah Ilmu Administrasi Negara Dinamika Governance : Jurnal Ilmu Administrasi Negara Publica: Jurnal Pemikiran Administrasi Negara Jurnal Ilmu Administrasi: Media Pengembangan Ilmu dan Praktek Administrasi Jurnal Pendidikan dan Kewirausahaan Community Development Journal: Jurnal Pengabdian Masyarakat Jurnal Ilmu Administrasi Negara ASIAN (Asosiasi Ilmuwan Administrasi Negara) Jurnal Bisnisman : Riset Bisnis dan Manajemen International Journal of Social and Management Studies (IJOSMAS) Jurnal Kewarganegaraan Arkus Jurnal Pengabdian Kepada Masyarakat Jurnal Ekonomi Jurnal Abdi Masyarakat Indonesia East Asian Journal of Multidisciplinary Research (EAJMR) Majalah Ilmiah Dinamika Administrasi (MIDA) Jurnal Pengabdian Masyarakat Tapis Berseri Jurnal Ilmu Administrasi: Media Pengembangan Ilmu dan Praktek Administrasi Jurnal Kesehatan Mahardika Jurnal Studi Pemerintahan Jurnal Pengabdian kepada Masyarakat
Anggara Setya Saputra
Jurusan Administrasi Negara, Universitas Wijayakusuma, Purwokerto, Indonesia
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Navigating the Iron Triangle: A Systematic Mixed-Methods Review of Equity and Quality Trade-offs in Indonesia’s National Health Insurance Reform Sutrisni; Anggara Setya Saputra; Indi Nurul Anisah; Arinda Retno Setiani; Fika meiliana Saputri
Arkus Vol. 11 No. 2 (2025): Arkus
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/arkus.v11i2.843

Abstract

As Indonesia’s Jaminan Kesehatan Nasional (JKN) transitions from an expansionary phase to maturity, it faces the classic iron triangle of health policy: the tension between expanding access, containing costs, and maintaining quality. While coverage rates have soared, critical questions remain regarding the equitable distribution of these benefits in a post-pandemic landscape. This study employs an Integrative Systematic Review design, synthesizing high-impact quantitative and qualitative evidence published between 2021 and 2024. Data were extracted from six primary studies utilizing large-scale national datasets (SUSENAS, IFLS) and policy reviews. The analysis moves beyond simple pooling to perform a narrative synthesis of adjusted Odds Ratios (aOR) for utilization and benefit incidence, assessing the structural determinants of effective coverage. The synthesis reveals a distinct inverse equity trade-off. While JKN ownership significantly increases the probability of inpatient utilization (aOR: 2.35), the benefits are unevenly distributed. A middle-class capture phenomenon is evident, where upper-middle-income groups experience a 41% reduction in out-of-pocket (OOP) expenditure compared to 38% for the poorest quintile. Furthermore, a quality gap persists, with non-poor populations seeing a greater reduction in unmet needs (10.4%) than the poor (7.7%), largely driven by supply-side rigidities in remote areas and administrative literacy barriers. In conclusion, JKN has successfully dismantled financial entry barriers but has not yet resolved structural inequities. The system currently functions as a regressive subsidy where the urban middle class extracts disproportionate value. Future policy must pivot from coverage expansion to supply-side equity, implementing geographic capitation differentials and targeted non-medical benefits for vulnerable populations to close the gap between legal entitlement and effective access.
Co-Authors ABDUL MANAP Agustina, Alfriansa Agustina, Alfriansa Alfriansa Agustina Ana Fitriyatul Bilgies Andri Trianfano Arinda Retno Setiani Arkam Lahiya Budi Sulistiyo Nugroho Chamid Sutikno Chamid Sutikno Chamid Sutikno Citra Arta, Deddy Novie Dasep Supriatna Denok Kurniasih Denok Kurniasih Denok Kurniasih Devit Bagus Indranika Devit Bagus Indranika Eddy Silamat Eddy Silamat, Eddy Emiraldo Win Pazqara Fachry Abda El Rahman Faqih Nabhan Felisia Purnawanti Fika meiliana Saputri Gamar Al Haddar Gita Nagiyanti Handy Ferdiansyah Harliana Harliana I Gusti Kade Budhi Harryarsana Iin Piani Ika Suhartanti Darmo Indi Nurul Anisah Indranika, Devit Bagus Johar Mamuri Kurniasih, Denok Kusumaningsih, Oti Kusumaningtias, Eka Lestari, Mery Lita Ningrum Afriani Luckhy Natalia Anastasye Lotte Mahardhani, Ardhana Januar Merintha Suryapuspita Muchamad Arif Al Ardha Muhamad Yusuf Muhamad Yusuf, SE., M.Si. Muhammad Hidayat Mujib, Mujib Nidya Ayu Wulandari Ramdan Norvadewi Oti Kusumaningsih Paulus Israwan Setyoko Ranjani, Ranjani Rasmawati A. R. Rinovian Rais Sartono - Sartono Sartono Setyoko, Paulus Israwan Silvy Sondari Gadzali Siti Chaerunisa Supardi Hamid Suryoto Suryoto Suryoto, Suryoto Sutrisni Teddy Rusmawan Titi Rahmawati Ulfah Nur Hakimah Widyaningsih, Faulia Zarkasi, Zarkasi