Further expansion of insurance coverage is expected to be especially challenging since many of the people currently not covered are in the informal sector. In addition, ensuring access to quality health services remains an issue, especially in the rural or remote areas of the country.

Jamkesmas - a government-financed health insurance program for the poor and near-poor - is currently Indonesia’s largest insurance program. The program is expected to be integrated and merged with all other social insurance programs under a single-payer umbrella by 2014. Jamkesmas has been operational since 2005, and an assessment of its implementation can provide valuable lessons for informing future policy initiatives aimed at attaining universal health coverage. The program is centrally managed and financed by the Ministry of Health and provides coverage to more than 76 million people. Although the program is designed with good intentions, it is performing well below its potential in terms of attaining its outcomes.

On the positive side, about 40 percent of poor and near-poor households are covered under the program, outpatient and inpatient utilization rates have increased among program cardholders, levels of catastrophic payments have declined, and there is generally a positive perception with regard to the program among those who are enrolled. There is increasing participation of the private providers under Jamkesmas, and more than 300 complementary local Jamkesmas-inspired programs have been initiated across the country. However, on the negative side, there is evidence of high levels of mistargeting and leakages to the non-poor, low levels of socialization as well as awareness of benefits, low utilization and relatively low quality of care, regional inconsistencies in the availability of the basic benefits package, relatively shallow levels of financial protection, and poor accountability and feedback mechanisms.

Read the World Bank's full report here