Nusa Dua, Bali. Indonesia’s national health insurer, BPJS Kesehatan, is ramping up efforts to ensure the long-term sustainability of its universal health coverage program (JKN) by strengthening its referral system and optimizing healthcare spending.

CEO Ghufron Mukti said that the JKN program -- now covering more than 280 million Indonesians -- has become a symbol of public trust in the national health system. However, this success also brings significant financing challenges that require strategic reform to maintain service quality and financial stability.

“Rising demand for higher-quality healthcare pushes us to continuously innovate while safeguarding the Social Security Fund,” Ghufron said at the Pre-Congress of the International Health Economics Association (IHEA) World Congress on Health Economics on Sunday.

BPJS Kesehatan is currently formulating a more effective and efficient healthcare spending strategy by reinforcing its referral system. The goal is to ensure that JKN participants receive appropriate care based on their medical needs, in the right healthcare setting -- thereby avoiding unnecessary spending and service overuse.

“High claim volumes reflect the public’s trust in JKN,” Ghufron said. “But to keep the Social Security Fund sustainable amid rising claims, we need strategic innovations that maintain service quality and accessibility for all Indonesians.”

At the IHEA event, BPJS Kesehatan also held discussions with representatives from countries such as Thailand and South Korea to exchange knowledge on financing strategies and long-term care development.

Mahlil Ruby, Director of Planning and Development at BPJS Kesehatan, stressed the need for innovative financing models to improve service efficiency -- particularly for high-cost and potentially overused services.

“The future success of JKN depends not only on membership coverage, but also on our ability to ensure financial sustainability, enhance service quality, and guarantee fair and equitable access to care for all segments of the population,” Mahlil said.

Mahlil also expressed optimism that BPJS Kesehatan could serve as a model for other countries looking to strengthen national health financing systems and long-term care programs.

“We aim to ensure our financing strategies support the continuity of the program while maintaining high-quality healthcare services for all members,” he added.

Also participating in the panel discussion were Piyanart Luangwilaiwan from Thailand’s National Health Security Office (NHSO) and Hyunjin Cho, Deputy Director at South Korea’s National Health Insurance Service (NHIS).

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