Birth of the Largest Single Payer System, the National Health Insurance, in Indonesia

Currently, Indonesia administers the largest coverage Medicaid scheme (Jamkesmas) covering 76.4 million poorest Indonesia. In addition, there are 20 million workers and their family members covered by social health insurance schemes. After long battle between the Parliament and the Government under pressures from labor unions, non-government organizations, students and other civil societies, in October 2011, a law creating the National Health Insurance Corporation (NHIC), a single payer to administer the NHI of Indonesia (Ina-Medicare) was passed. The political processes, labors demonstration, women for the NHI, and threats for the national strike, finally the Government agreed to pass the law. The overall legal development took almost two years with full and intense political battle by stakeholders. Conflicts, legal, and political maneuvers often observed by various stakeholders who pro and contra the NHIC. The establishment of NHIC followed the same movement of a single payer system in Taiwan, the Philippine, and South Korea. The birth of the Ina-Medicare by NHIC of Indonesia, scheduled to fully operation in January 2014, poses management challenges to provide universal health coverage for 237 million people living in more than 5,000 islands of Indonesia. The Ina-Medicare would provide comprehensive health coverage in public and private providers using prospective payment systems. The payment levels may vary across regions. The contribution is expected to be about 5% of monthly salary. The progresses of massive growth of health insurance coverage and the political process to establish NHIC will be presented and discussed.