PENGARUH PENGEMBANGAN JAMINAN KESEHATAN BALI MANDARA TERHADAP KEBERADAAN JAMINAN KESEHATAN TINGKAT KABUPATEN DI BALI DAN UPAYA PENCAPAIAN UNIVERSAL COVERAGE

Abstract

Background: To conduct an analysis of the influence of the
Bali Mandara Health Insurance (JKBM) policy concerning the
existence of district level health insurance and its impact on
achieving universal coverage.
Method: Literature review to produce an analysis of JKBM
policy and to produce appropriate policy alternatives for
financing and health care issues which emerged from the
implementation of JKBM.
Results: The aim of Bali Mandara Health Insurance is to provide
health services which are fully subsidized by the Provincial
and Districts Government in Bali. JKBM is intended for peoples
who do not protected by health insurance programs. The
implementation of JKBM has forced Tabanan to stop the Askes
Mandiri program while Jembrana District decided not to take
part in JKBM. Unlike JKJ and Askes Mandiri, JKBM is still managed
by a coordination team under Bali Health Office Supervision.
Furthermore another fundamental difference is regarding on
how they finance the program. JKBM is fully financed from
sharing subsidies while JKJ and Askes Mandiri are financed
from member premium. Nevertheless JKBM policy is potential
to expand the efforts of achieving universal coverage, improve
equity in health financing and fulfil a non-profit principle of
social health insurance. Along with the positives impact, this
program also has several weaknesses. One of the
weaknesses is lack of consideration to the principles of social
solidarity and mutual cooperation. Communities’ participation in
health financing program which has been developed by JKJ
and Askes Mandiri is abandoned. In addition to these
weaknesses JKBM also less able to adopt the district health
insurance who have first evolved. JKJ case shows of JKBM
failure to apply the principle of portability and benef its
coordination of the services thereby potentially harming the
people of Bali.
Conclusion: Bali provincial government should immediately
develop Implementing Agency (Badan Pelaksana) of JKBM to
organize and develop the program. In addition to this, member
participation throughout premium payment could be established
gradually to ensure the sustainability of the program. JKJ and
JKBM should operate in harmony by considering role distribution
between member, Provincial Government of Bali, and
Government of Jembrana.
Keywords: health insurance and universal coverage