Healthcare for the ‘missing middle’

Around 100 million Indonesians don’t have health coverage, despite a bold national overhaul in 2014 of Indonesian healthcare aimed at bringing all the historically-fragmented insurance schemes together into the Jaminan Kesehatan Nasional (JKN), or National Health Insurance Programme. Indonesian and Australian researchers want to know how this can be improved.

The scheme sought to capture those who fall through the gaps, to achieve universal health coverage for all by 2019. Referred to as the ‘missing middle,’ they’re the people who aren’t destitute and receiving government help, but are still too poor to afford basic healthcare.

“There’s limited information about expanding health coverage where there’s a large ‘informal’ workforce, so I hope our work will provide valuable information for Indonesian policy makers,” says Dr Teguh Dartanto, of Universitas Indonesia and co-leader of the research that’s funded by The Australia-Indonesia Centre.

“Universal health coverage not only benefits Indonesia, but it’s also part of an international agenda of sustainable development goals— so the Indonesian experience could be a lesson for other countries,” Teguh says.

“The program works in compulsory sectors, where they have a surplus from premiums coming in compared to claims going out,” says co-leader of the project Dr Robert Sparrow, of the Australian National University.

“But in the voluntary sector, the cost of paying for healthcare is more than six times what they’re bringing in, because only sick people are enrolling.”