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All Journal Journal Health & Science : Gorontalo Journal Health and Science Community International Journal of Health and Pharmaceutical (IJHP)
Ghutsa Daud, Alfani
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Health Professions Nursing Public Health

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Health Insurance Model In The Perspective Of Health Economics: Transformation, Regulation, And Implementation In Indonesia agustina, Ariska; Paramita Putri, Prima; Kusumastuti Setianingrum, Evi; Hartono, Budi; Ghutsa Daud, Alfani
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 3 (2025): August 2025 (Indonesia - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i3.421

Abstract

Health insurance is an important component of the health financing system that aims to ensure equitable and sustainable access to health services. From a health economics perspective, the insurance system is able to mitigate the financial risk of illness while managing the efficiency and distribution of financing collectively. This study examines the development of health insurance models in Indonesia, ranging from traditional, modern, to managed care models, and analyses the challenges and implementation strategies of the National Health Insurance (JKN) programme by BPJS Kesehatan. A qualitative approach based on literature study was used with data sources from scientific journals, national regulations, BPJS Kesehatan reports, and public policy documents.The results show that the traditional model tends to be inefficient because it is prone to overutilisation and fraud. Modern models and managed care provide solutions through quality and cost control. However, the implementation of JKN in Indonesia still faces various challenges, such as delays in claim payments, moral hazard, and financing imbalances. One strategy for system sustainability is through the optimisation of participant fund assets, which can be productively invested to support promotive services, infrastructure, and strengthening the healthcare system. With transparent governance, the results of this asset optimisation can be returned for the benefit of the wider community. This study is expected to be a scientific contribution in supporting health financing policy reforms that are inclusive, efficient, and sustainable.
Evaluation of Capitation Scheme as a Financing Instrument for Primary Services in the National Health Insurance (NHI): A Review of Health Economics Literature Christine, Grace; Anindhita Sekarsari, Ayu; Irawan, Budy; Hartono, Budi; Ghutsa Daud, Alfani
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 3 (2025): August 2025 (Indonesia - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i3.380

Abstract

The study discuss about the capitation scheme is the main financing mechanism for primary healthcare services in the National Health Insurance (NHI), aimed at expanding access, promoting cost efficiency and strengthening promotive and preventive services at First Level Health Facilities (FLHF). This study aims to evaluate performance and effectiveness of capitation schemes as a strategic financing instrument in NHI’s system. Through a narrative- thematic literature review of 20 relevant publications from 2021–2025, this study examines four key aspects: the capitation policy structure, its impact on service quality and coverage, financing efficiency and administrative barriers. The results indicate that while capitation supports financial stability and increases visitation volume, its impact on clinical service quality and promotive-preventive service coverage remains limited. Key barriers include fragmented digital systems (P-Care, SIKDA, e-Kinerja), inadequate managerial capacity and a mismatch between performance indicators and clinical outcomes. This study recommends governance reforms based on output indicators, integration of digital reporting systems, as well as the implementation of a hybrid financing model. Strengthening capitation as a contextual, adaptive and performance-based strategic purchasing instrument is key to sustainable primary service financing within NHI’s framework.  
KONSEP DASAR EKONOMI KESEHATAN DAN APLIKASINYA DALAM SISTEM PELAYANAN KESEHATAN : TINJUAUAN LITERATUR Green Nego, Ingrid; Oktaviani Yustedjo, Dika; Parlindungan, Hotmada; Hartono, Budi; Ghutsa Daud, Alfani
Journal Health & Science : Gorontalo Journal Health and Science Community Vol 9, No 4 (2025): OKTOBER: JOURNAL HEALTH AND SCIENCE : GORONTALO JOURNAL HEALTH AND SCIENCE COMMU
Publisher : Gorontalo State University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35971/gojhes.v9i4.34207

Abstract

Kenaikan biaya layanan kesehatan global serta tuntutan pencapaian Cakupan Kesehatan Semesta (UHC) menuntut strategi alokasi sumber daya yang efisien dan adil. Ekonomi kesehatan menjadi kerangka analitis untuk menilai intervensi, efektivitas biaya, dan distribusi manfaat kesehatan. Studi ini merupakan narrative integrative review terhadap 20 artikel peer-reviewed (2020–2025) yang diperoleh melalui PubMed Central, DOAJ, dan repositori institusi menggunakan kata kunci “health economics” “cost-effectiveness” “resource allocation” “efficiency” dan “health system management”. Hasil menunjukkan bahwa evaluasi ekonomi—cost-effectiveness, cost-utility, cost-benefit, dan cost-minimization—menjadi instrumen utama prioritisasi intervensi; teknik manajerial seperti Just-In-Time dan Total Quality Control efektif mengurangi pemborosan; metode lanjut seperti probabilistic sensitivity analysis dan distributional cost-effectiveness analysis mengintegrasikan aspek keadilan; sementara kerangka Health Technology Assessment (HTA) adaptif diterapkan mulai dari QALY threshold di Inggris hingga causal loop diagrams di Thailand. Hambatan utama meliputi keterbatasan data dan kurangnya tenaga terlatih, sedangkan manfaatnya mencakup efisiensi biaya, perluasan akses, dan keberlanjutan pembiayaan. Kesimpulannya, ekonomi kesehatan memberikan kerangka komprehensif untuk meningkatkan mutu, aksesibilitas, dan keberlanjutan sistem pelayanan kesehatan, serta dapat menjadi dasar pengambilan keputusan berbasis bukti. Kebaruan penelitian ini terletak pada sintesis komprehensif yang tidak hanya menekankan efisiensi biaya, tetapi juga integrasi prinsip keadilan (equity) melalui pendekatan distribusional dan prosedur fairness, sehingga ekonomi kesehatan diposisikan bukan semata alat penghematan, melainkan instrumen strategis dalam pemerataan akses dan penguatan kebijakan kesehatan berkelanjutan 
Co-Authors Agustina, Ariska Anindhita Sekarsari, Ayu Budi Hartono Christine, Grace Green Nego, Ingrid Irawan, Budy Kusumastuti Setianingrum, Evi Oktaviani Yustedjo, Dika Paramita Putri, Prima Parlindungan, Hotmada