Reforming Indonesia’s National Health Insurance Through Debt Relief

 By Kusnandar & Co., Attorneys At Law – Jakarta, Indonesia

 

The government’s plan to write off Rp 26.47 trillion in overdue BPJS Kesehatan contributions is more than a technical fiscal decision—it is a defining moment for Indonesia’s national health insurance system. The proposed policy, reportedly awaiting final approval, touches on three fundamental issues: social justice, financial sustainability, and the state’s responsibility in guaranteeing access to healthcare.

 

At its core, the National Health Insurance (JKN) program was established to ensure that healthcare is not a privilege, but a right. In principle, it embodies the constitutional mandate that every citizen deserves access to medical services. Yet, in practice, millions of participants have fallen into inactive status due to unpaid premiums. For many, arrears accumulated not out of deliberate negligence but because of economic hardship, job loss, informal employment instability, or administrative barriers. When contributions go unpaid, access to healthcare services can be suspended, placing vulnerable families in an even more precarious position.

 

From a humanitarian perspective, the proposed write-off offers relief to millions of Indonesians. It provides an opportunity for inactive participants—particularly low-income, informal sector workers—to regain access to essential healthcare without the burden of overwhelming debt. In times of rising living costs and economic uncertainty, such a policy signals that the state prioritizes public welfare over rigid financial enforcement. It reframes the government not as a debt collector, but as a social protector.

 

However, this policy also raises critical concerns about the long-term sustainability of BPJS Kesehatan. The JKN system has historically faced financial pressure due to the imbalance between collected premiums and healthcare claims paid out. The existence of massive arrears reveals deeper structural issues: inconsistent premium compliance, weaknesses in contribution collection mechanisms, and outdated or fragmented participant data. Writing off Rp 26.47 trillion may resolve an administrative backlog, but it does not automatically solve the underlying systemic challenges.

 

There is also the issue of fairness. Millions of Indonesians have consistently paid their premiums despite economic difficulties. For them, a blanket write-off could appear inequitable, potentially creating a moral hazard where participants perceive that non-payment carries little consequence. If not carefully designed, the policy may unintentionally weaken payment discipline in the future. This is why the government must ensure that any debt relief mechanism is targeted—limited to genuinely vulnerable groups verified through accurate and integrated social welfare data.

 

The success of this policy ultimately depends on accompanying structural reforms. First, the government should strengthen data integration across ministries and agencies to ensure accurate classification of beneficiaries and contributors. Second, BPJS Kesehatan must modernize its collection and monitoring systems, possibly leveraging digital tools to track contributions in real time and reduce administrative gaps. Third, public education campaigns are needed to reinforce the principle that JKN is built on shared responsibility: solidarity works only when contributions are consistent.

 

Moreover, policymakers must treat this write-off not as a one-time political gesture, but as part of a broader reform agenda. Sustainable universal health coverage requires predictable funding, improved governance, and transparent accountability. Without these, similar arrears could re-emerge in the future, forcing the state into repeated cycles of financial forgiveness.

 

Rp 26.47 trillion is a significant figure, but the real issue goes beyond numbers. It reflects the tension between compassion and fiscal prudence, between social protection and institutional discipline. If implemented carefully and paired with systemic improvements, the policy could strengthen public trust in the national health insurance system. If handled poorly, it risks undermining financial stability and fairness.

 

Ultimately, the government faces a delicate balancing act: ensuring healthcare access for the most vulnerable while preserving the integrity and sustainability of Indonesia’s universal health coverage system.

By : K&Co - February 11, 2026