Holistic Evaluation of the National Health Insurance Program in the Local Context of Indonesia

Abstract

This article reviews the evaluation of the National Health Insurance policy, exploring various aspects such as effectiveness, efficiency, adequacy, leveling, responsiveness, and accuracy in its implementation. Researchers use the case study method with a qualitative approach to describe and analyze phenomena, events, attitudes, social activities, and perceptions of individuals and groups related to the National Health Insurance program. This study analyses the effectiveness, efficiency, adequacy, leveling, responsiveness, and accuracy of National Health Insurance program policies in a region. The results showed that 1) The effectiveness of the National Health Insurance policy is still not optimal due to the lack of employee commitment in implementing the work agreement mechanism between the Regional Government and BPJS Kesehatan Boroko Branch. 2) In terms of efficiency, the implementation of standard operating procedures has shown optimality, but there are still obstacles related to administrative requirements for eligible prospective National Health Insurance policy participants. 3) The adequacy of the National Health Insurance policies have not been effective due to an increase in new participants, that is, not balanced with the available budget, resulting in delays in service claims for health workers. 4) The leveling of the National Health Insurance policy has not been effective due to constraints in recipient data, which resulted in a reduction in the quota from BPJS Kesehatan, leaving deserving community groups without assistance. 5) The responsiveness of this policy is disrupted by the validation of the criteria for recipients of contribution assistance which is not synchronized with the regional budget and the lack of direct data submission when applicants submit a poor statement letter at the village level. 6) The accuracy of this policy is still limited by the limitations of the regional budget in reaching all communities covered by this program in North Bolaang Mongondow Regency.
 Keywords: policy, evaluation, national health insurance