Draft Presidential Regulation on JKN to Be Issued Soon, Ministry of Health Prepares Competency-Based Referral Scheme

The Government, through the Ministry of Health (Kementerian Kesehatan – “Kemenkes”), is finalizing the implementation of a competency-based referral scheme for participants of the National Health Insurance (Jaminan Kesehatan Nasional – “JKN”). This scheme is planned to take effect after the Draft Presidential Regulation (Peraturan Presiden – “Perpres”) on Health Insurance is promulgated.

“The Perpres will be issued shortly, so the scheme will come into effect this year,” said Budi Gunadi Sadikin, the Minister of Health, to Hukumonline.

Under this policy, the tiered referral system based on hospital classes D–C–B–A will be abolished. Under the new scheme, the referring medical doctor will input the patient’s diagnosis and the required procedures or medical treatments, which will then be processed automatically by the system to direct the patient to a healthcare facility or hospital with the appropriate level of competence.

The Ministry of Health considers that the competency-based referral scheme may improve the efficiency of JKN financing by reducing patient transfers between hospitals. Based on initial simulations, the policy has the potential to increase health insurance fund expenditures by approximately 0.64–1.69%; however, the financial condition of the JKN fund is considered to remain within a safe range.

“This will be facilitated through the Satu Sehat apps. Participants will be referred to healthcare facilities that are competent and appropriate to their clinical condition and medical needs,” said Obrin Parulian, Director of Clinical Services at the Ministry of Health.