American Journal of Humanities and Social Sciences Research (AJHSSR) 2024

American Journal of Humanities and Social Sciences Research (AJHSSR)

e-ISSN :2378-703X
Volume-08, Issue-04, pp-126-134
www.ajhssr.com
Research Paper Open Access

Reorientation of Health Service Governance Toward the

Fulfillment of Social Justice
Wayan Santoso
Master of Law, Postgraduate Program, Universitas Ngurah Rai, Indonesia
Corresponding author: Wayan Santoso.

ABSTRACT: Health insurance is a human right. At the practical level, this health insurance program in
Indonesia is organized by BPJS Kesehatan (Social Security Administering Body for Health). The
implementation of BPJS Kesehatan is still not optimal and effective. Three problems are discussed in this
writing: the dynamics of health insurance governance in Indonesia, the implementation of the fulfillment of the
right to health by BPJS Kesehatan, and the reorientation of BPJS Kesehatan services toward social justice.
These problems are then answered by scientific research methods using a sociological juridical approach.
Complaintsoften occur regarding the regulations, the services provided by the health facility providers, and the
distance between the community and the health facilities. Such complaints affect the public interest in becoming
BPJS Kesehatan participants. The aforementioned conditions must be considered and evaluated for the
government's success in the aspired national health insurance plan.
KEYWORDS -BPJS Kesehatan, Health Insurance, Social Justice

I. INTRODUCTION
Health is one of the community's basic rights that the government must guarantee. As early as 1948, the
World Health Organization (WHO) described health as “a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity”[1]. The obligation of the state to ensure public health
has been mandated in Article 28 H paragraph (1) of the 1945 Constitution. In that article, it is stated that
"everyone has the right to live in physical and spiritual prosperity, to have a place to live, and to have a good
and healthy living environment. and have the right to obtain health services. Law No. 36 of 2009 describes that
health is a condition where humans are physically, mentally, spiritually, and socially healthy to be economically
able to live a productive life [2].
The human right to health is a critical legal tool to achieve health justice, and universal health coverage
is included among the Sustainable Development Goals [3]. Therefore, people at all levels of the economy must
enjoy the right to health. As a proportion of the Indonesian people is still on the verge of the poverty line;
therefore, to help the community and reduce the burden on the community in bearing the high health costs, a
system that can use the concept of gotong royong (mutual assistance) is needed to reduce the burden on the
community in bearing the high health costs. Therefore, hopefully,no more people cannot enjoy health facilities
because of financial disadvantages.
The government is legally responsible for creating a good quality health service system. Health
insurance has an important role and function in supporting the life of the nation and state. As part of its
responsibilities, the government has made efforts to design health insurance programs that can meet the
community’s basic needs Health insurance programs that have been run by the government such as Jamkesmas,
Jamkesda, ASKES, and the latest public health program are the government programs called the Social Security
Administering Body (BPJS) [4]. The legal rules regarding BPJS are regulated in Law Number 24 of 2011
concerning BPJS. The government formed BPJS in two social security administration bodies, namely BPJS
Kesehatan and BPJS Ketenagakerjaan (employment). BPJS Kesehatan is a State-Owned Enterprise (BUMN)
specifically tasked with administering health insurance for all Indonesian people [5]. The health insurance
program organized by the government is implemented by PT Askes (Persero) and PT. Jamsostek (Persero). This
program is applied to civil servants, private employees, veterans, and retired recipients. Meanwhile, the general
public can use other insurance programs such as Jamkesmas (Community Health Insurance) and Jamkesda
(Regional Health Insurance), especially for the poor and underprivileged. However, based on the Regulation of
the Minister of Health Number 28 of 2014 concerning Guidelines for the Implementation of National Health
Insurance, the social security program has not run effectively and efficiently, causing the cost and quality of

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services for BPJS participants not to be controlled effectively [6].
Many people complain about services from BPJS. It can be seen from the number of reports received
by the Ombudsman of the Republic of Indonesia (ORI), including reports made by the public regarding the
BPJS management bureaucracy, registration process, queues, and services, including payment methods from
BPJS [7]. BPJS, as a public health insurance provider, is tasked with expanding community participation as
BPJS participants. In the Presidential Regulation of the Republic of Indonesia Number 12 of 2013 concerning
health insurance, it is stated that health insurance is a guarantee of health protection so that the participants can
obtain health care benefits and protection in fulfilling the basic health needs given to everyone who has paid the
health fees. Health insurance participants are classified into Health Insurance Contribution Assistance
Recipients and Non-Insurance Contribution Assistance Recipients. In particular, Contribution Assistance
Recipients are regulated in the Government Regulation of the Republic of Indonesia Number 101 of 2012
concerning the Regulation of Health Insurance Outcomes Assistance. The regulation states that the recipients of
contribution assistance are people classified as poor and those who cannot afford it. In contrast, those who are
not recipients of contribution assistance are BPJS participants who are not classified as poor, consisting of wage
workers and their family members, non-wage workers and their family members, and non-workers and their
family members [8].
As the mandate given to BPJS is to reach all Indonesian people as BPJS participants, there are
obstacles to asking the public to become BPJS participants. Interest is a tendency from within based on the need
for the will or desire for certain things. The community's interestin being BPJS participants is influenced by
knowledge and costs. Whereas in creating social justice, health insurance should be the full responsibility of the
government. Other researchers have written several studies related to this research, including Solechan, who
researched the "Social Security Administering Body (BPJS) for Health as a Public Service." This study aimed to
determine the role of BPJS Kesehatan as a form of public service in Indonesia [9]. Endang Kusuma Astuti
researched "The Role of BPJS Kesehatan in Realizing the Right to Health Services for Indonesian Citizens."
The results show the government’s role in realizing Indonesian citizens' right to health services through BPJS
Kesehatan. The inhibiting factors for implementing BPJS Kesehatan for the community include the problem of
tariffs and medicines, membership, complexity, quality of service, referrals, socialization of the BPJS program,
and Jamkesmas not being included in BPJS participants [10]. Mikho Ardinata researched "State Responsibilities
of Health Guarantee in The Perspective of Human Rights." The results of this study indicate that in fulfilling the
basic rights of citizens to health, the government is bound by the responsibility to ensure adequate access for
every citizen to the proper and optimal health services. It is an effort to respect, protect, and fulfill state
obligations by implementing human rights norms on the right to health [11].
The type of research used in this study is sociological juridical legal research. Sociological juridical
legal research is legal research that examines the applicable legal provisions with the facts that exist in society
[12]. In sociological juridical legal research, a sociological juridical approach is conducted by looking at the
legal reality that exists in the community; in this study, the legal reality is related to the implementation of the
BPJS Kesehatan program launched by the government and how the interest of the community to participate as
BPJS Kesehatan participants. In this study, the sources of legal materials are from primary legal sources, namely
the laws and regulations relating to the implementation of BPJS Kesehatan as follows: Presidential Instruction
of the Republic of Indonesia Number 1 of 2022 concerning Optimizing the Implementation of the National
Health Insurance Program, Presidential Regulation Number 64 of 2020 concerning the Second Amendment to
Presidential Regulation Number 82 of 2018 concerning Health Insurance, Presidential Regulation Number 75 of
2019 concerning Amendments to Presidential Regulation Number 82 of 2018 concerning Health Insurance,
Presidential Regulation No. 12 of 2013 concerning Health Insurance, and Presidential Regulation No. 111 of
2013 concerning Amendments to Presidential Regulation No. 12 of 2013 concerning Health Insurance. The data
obtained were then analyzed and described systematically to obtain information about the problems that are the
subject of discussion in this study to find answers to the problems formulated in this study.

II. DISCUSSION
1. Dynamics of Health Insurance Governance in Indonesia
Each country defines the conditions for realizing the right to health care to guarantee people’s health.
The state itself assumes the controller's obligations and protects this right [13]. In carrying out the legal
obligations to provide health to the public, the government prepares a health insurance program for the entire
community. The health insurance program for the community in Indonesia has existed since the Dutch colonial
era. During the Dutch government era, health insurance was only given to government employees and family
members of government employees. After Indonesian independence and the end of the Dutch colonial
government, the Indonesian state government fully held the government. Regarding health insurance, it was still
maintained with the issuance of Minister of Health Regulation No. 1 of 1968 by establishing an agency tasked
with administering health for state employees and retirees. The agency is the Health Maintenance Fund

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Organizing Agency [14].
Health services launched by stakeholders in the health sector vary widely depending on the willingness
to comply with health standards to improve Indonesian people’s health status. WHO defines an overall health
system outcome or goal as improving health and equity in health in a responsive, financially equitable manner
and making the best or most efficient use of available resources [15]. The improvement of public health in
Indonesia compared to developing countries can be said to be not optimal. The government's main focus is to
maximize the development of public health. For this reason, the government has issued Law Number 40 of 2004
concerning the National Social Security System. This provision states that everyone has the right to social
security to meet the basic needs of a decent life for humanity and to increase human dignity toward a prosperous
and just Indonesian society. Social security as a whole is also proclaimed in this provision, where the state
designed a social security system for the Indonesian people known as the National Health Insurance. The
National Health Insurance is health protection where it is expected that participants of this health insurance can
benefit from the health care and protection in fulfilling the basic needs for health insurance provided to people
who are participants of the National Health Insurance and pay the health insurance contributions to the
government. BPJS administers the national health insurance.
The community's need for a service and facility designed by the government to reach all levels of
society shall not only be enjoyed by the wealthy as if it is health insurance provided by private commercial
insurance. As a legal entity formed by the Government, BPJS Kesehatan is here to provide guarantees to the
community to meet the community's needs for maximum health insurance. In 1984, in Government Regulation
Numbers 22 and 23, the Health Maintenance Fund Organizing Agency was changed from an agency under the
auspices of the Ministry of Health to a State-Owned Enterprise, namely the Husada Bhakti Company [16]. The
range of health insurance under PerumHusada Bakti is no longer for government employees and retirees only
but also for Civil Servants, Retired Civil Servants, Veterans, independence pioneers, and their family members
[17].
PerumHusada Bakti then changed its status to PT Askes (Persero) through Government Regulation No.
6 of 1992. PT Askes is responsible for implementing a health insurance program for the poor or people
classified as poor, called Askeskin [18]. PT Askes later changed to BPJS Kesehatan after the issuance of Law
Number 24 of 2011 concerning the Social Security Administering Body (BPJS) [19]. BPJS Kesehatan, as a
business entity formed by the government as a public servant, has norms in carrying out its duties based on what
has been mandated in Law Number 24 of 2011 concerning BPJS, as follows:
1. As an agency established by statutory regulation, BPJS carries out its function to organize the
public interest, namely the National Social Security System (SJSN), which is based on the
principles of humanity, benefits, and social justice for all Indonesian people;
2. BPJS is given the delegation of authority to make regulations regarding the implementation and
public health insurance to improve the public interest;
3. BPJS Kesehatan is given the authority to manage incoming funds from the public as BPJS
participants;
4. Based on its authority, BPJS can supervise and check the compliance of BPJS participants in
fulfilling their rights according to what has been determined, including guaranteeing that
participants get their rights;
5. BPJS can represent the country as a member of international health institutions. The President
appoints members of the supervisory board and directors of BPJS through public selection. BPJS
shall provide accountability for implementing these duties through program management reports
and financial reports to the President, which are then copied to DJSN.
BPJS Kesehatan, in carrying out its duties and authorities, is regulated in Article 10 of the Law. BPJS
is in charge of conducting and/or receiving registration of BPJS participants, collecting contributions from BPJS
Kesehatan participants, receiving contribution assistance from the government, managing social security funds
for the benefit of social security participants, collecting and processing data from social security participants,
making payments for benefits and/or costs of health services to health facilities by the provisions stipulated in
the health insurance program and disseminating information regarding programs run by BPJS to participants and
the wider community. Since the implementation of the health service program by BPJS Kesehatan, there has
been a transfer of functions and duties to several state institutions, where the Ministry of Health no longer
carries out a health insurance program called Jamkesmas, along with the functions of the Ministry of Defence,
the National Army and the Police, which used to carry out health service, as BPJS, PT Jamsostek, now runs such
programs.

2. Implementation of The Fulfilment of The Right to Health by BPJS Kesehatan

Governance is central to improving health sector performance and achieving universal health coverage
[20]. Good management will have implications for wider access to health services and the increasing quality of

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health services. Health insurance can be implemented with the support of the readiness of stakeholders, namely
BPJS Kesehatan, the Health Office, and health facility providers (Hospitals, Health Centers, Health Clinics, and
Private Practice Clinics) [21]. As a developing country, Indonesia faces a crucial issue concerning providing
health services to the public [22]. Therefore, an evaluation is necessary. The evaluation is an activity to collect
information about whether a system is working; therefore, the results can be used to determine alternatives in
making the right decisions to improve or maintain an existing system. Indications of problems in implementing
the national health insurance program carried out by the Social Security Implementing Body are related to the
technical implementation of health insurance.
Based on the objectives of BPJS as regulated in Article 3 of Law Number 4 of 2011 concerning social
security administering bodies, BPJS aims to realize the provision of guarantees that can meet the basic needs of
a decent life for BPJS participants. Evaluation of the implementation of BPJS Kesehatan can be seen from
several variables, as follows [23]:
1. Indicators of Availability of Health Facilities
Health insurance implementation comprises several interrelated aspects: regulatory,
participation, benefits and dues, and health. All Indonesian residents must be health insurance
participants managed by BPJS, including foreigners who have worked for at least six months in
Indonesia and have paid dues. The group of BPJS Kesehatan participants consists of two groups: the
recipients of health insurance contributions and not the recipients of health insurance contributions
[24]. Health facilities are facilities used to carry out health services. In the Regulation of the Minister of
Health, Number 6 of 2013, health facilities are part of health service facilities. Health service facilities
consist of 3, namely, a. first-level health facilities, b. second-level health facilities, and c. third-level
health facilities.
The first-level health facility is Puskesmas. Puskesmas is a health service technical
implementing unit (UPTD) for the district or city responsible for carrying out health development
within its coverage area. Health services that can be provided at the Puskesmas include comprehensive,
integrated, and sustainable first-level health services for individuals and the community. The second
health facility is a hospital. Hospitals are advanced health facilities [25].In the regulation of the
Minister of Health of Indonesia Number No. 1204/Menkes/SK/X/2004 concerning Hospital
Environmental Health Requirements, a hospital is defined as a health service facility gathering place
for sick and healthy people. Meanwhile, in the Regulation of the Minister of Health of the Republic of
Indonesia, No. 340/MENKES/PER/III/2010, a hospital is defined as a health service institution that
provides complete health services to individuals by providing inpatient, outpatient, and emergency
services.
Health service indicator variables related to the availability of health facilities for BPJS
participants are highly dependent on the quality of health services assessed based on the level of
service provided to satisfy patients and users of health facilities services. The implementation of good
health services has specific standards determined by the standard code of ethics set by the Ministry of
Health and related agencies. There are often complaints about services from health facility providers to
patients using BPJS in the community. Many reports are received by the Indonesian Ombudsman
related to BPJS services, hospitals' rejection of BPJS patients, and certain medical actions, such as
surgery. BPJS patients have difficulty getting surgery schedules, or the operation is often postponed.
This raises an assumption in the community that health facility providers will prioritize general patients
over patients using BPJS Kesehatan [26].
2. Regulatory Relevance Indicators
Relevance is compatible or related to one another. Regulation is a set of rules promulgated by
the holder of power (government) that regulate the running of an activity. Regulations are made to
regulate people's behavior so that they act by applicable rules. Therefore, the rules that have been set
can be implemented properly. Regulations are issued as restrictions as an effort from the state as a
benchmark for implementation to prevent failure or irregularities in a regulation. BPJS Kesehatan
regulations that have been issued by the government include: BPJS Kesehatan Regulation Number 6 of
2020 concerning the Fraud Prevention System in the Implementation of the Health Insurance Program;
BPJS Kesehatan Regulation Number 5 of 2020 concerning the Second Amendment to BPJS Kesehatan
Regulation No. 6 of 2018 concerning Administration of Health Insurance Program Participation; BPJS
Kesehatan Regulation Number 4 of 2020 concerning Technical Guidelines for Guaranteeing Health
Services with Additional Health Insurance in the Health Insurance Program; BPJS Kesehatan
Regulation Number 3 of 2020 concerning Procedures for Billing, Payment and Recording of Health
Insurance Contributions, and Payment of Fines Due to Late Payment of Health Insurance
Contributions; BPJS Kesehatan Regulation Number 2 of 2020 concerning Procedures for Guaranteeing
Glasses Refraction Services at First Level Health Facilities in the Health Insurance Program; BPJS

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Kesehatan Regulation Number 1 of 2020 concerning Procedures for Guaranteeing Cataract Surgery
and Medical Rehabilitation in the Health Insurance Program; BPJS Kesehatan Regulation Number 6 of
2019 concerning Amendments to BPJS Kesehatan Regulation Number 6 of 2018 concerning
Administration of Health Insurance Program Participation; BPJS Kesehatan Regulation Number 6 of
2019 concerning Amendments to BPJS Kesehatan Regulation Number 6 of 2018 concerning
Administration of Health Insurance Program Participation; BPJS Kesehatan Regulation Number 4 of
2019 concerning Transfer of Health Insurance Participants in First Level Health Facilities; BPJS
Kesehatan Regulation Number 3 of 2019; BPJS Kesehatan Regulation Number 2 of 2019 concerning
the Implementation of Health History Screening and Certain Health Screening or Screening Services
and Health Improvement for Participants with Chronic Diseases in the Health Insurance Program;
BPJS Kesehatan Regulation Number 1 of 2019 concerning Revocation of BPJS Kesehatan Regulation
Number 1 of 2018 concerning Emergency Assessment and Procedures for Reimbursement of
Emergency Services Fees; BPJS Kesehatan Regulation Number 7 of 2019 concerning Instructions for
Implementing Performance-Based Capitation Payments in FKTP; BPJS Kesehatan Regulation Number
7 concerning Management of Health Facility Claim Administration in the Implementation of Health
Insurance; BPJS Kesehatan Regulation Number 6 concerning Administration of Health Insurance
Program Participation; BPJS Kesehatan Regulation Number 5 concerning Procedures for Billing,
Payment and Recording of Health Insurance Contributions and Payment of Fines Due to Late Payment
of Health Insurance Contributions; Joint Regulation of BPJS Kesehatan and the Ministry of Health
Number 2 of 2017 concerning Technical Guidelines for the Implementation of Capitation Payments
Based on Fulfilment of Service Commitments at First Level Health Facilities; Regulation of the Health
Social Security Administering Body Number 3 of 2017 concerning Management of Health Facility
Claims Administration in the implementation of National Health Insurance; Regulation of the Health
Social Security Administering Body Number 1 of 2017 concerning the Equity of Participants in First
Level Health Facilities; BPJS Kesehatan Regulation Number 1 of 2018 concerning Emergency
Assessments and Procedures for Reimbursement of Emergency Services and BPJS Kesehatan
Regulations Number 1 of 2014 concerning the Implementation of Health Social Security.
The changing regulations regarding BPJS Kesehatan confuse the public, especially BPJS
Kesehatan participants. With regulations that continue to change, BPJS organizers must continuously
commit to disseminating information to the public. BPJS Kesehatan service flows for participants who
use BPJS Kesehatan services are considered difficult, as follows:
1) BPJS Kesehatan applies a service flow with a tiered referral system. With such flow,
participants must come first to the level I health facilities (faskes) designated in the
participant's BPJS membership. Level 1 health facilities are Puskesmas, family doctors or
clinics to obtain a referral letter. If there is an emergency, the patient can go directly to the
hospital or a specialist. The decision to be able to make a referral to a hospital is the authority
of a level 1 health facility;
2) Puskesmas, a level 1 health facility with the authority to issue referral letters, has limited
hours of activity, so that on weekends, namely Saturdays and Sundays, the Puskesmas is
closed. The limited operational hours of Puskesmas are a problem for BPJS Kesehatan
participants who are in an emergency. This also results in the accumulation of patient queues
during effective hours.
3) In the BPJS Kesehatan regulations, it is determined that BPJS Kesehatan participants may
only choose one health facility to obtain a referral letter. They choose the health facilities that
have collaborated with BPJS.
4) BPJS Kesehatan participants can only seek treatment at hospitals with a Cooperation
agreement with BPJS Health. Constraints on the limitations of health facilities in collaboration
with BPJS limit the selection of health facilities as BPJS health referrals and create
accumulations in hospitals that are BPJS Health referrals.
5) In the BPJS Kesehatan program, the room facilities offered are standard rooms up to class 1.
BPJS participants cannot use VIP facilities, so participants who want to be treated using room
facilities with standards above class 1 will be charged additional fees according to the price
rate determined by each health facility (hospital).
3. Human Resources Indicator
Human resource indicators are the main indicators of implementing the health insurance
program. Minimum service standards in the health sector become a benchmark for performance in the
health service sector organized by the government, through local or centralized government. The
government gives authority to district or city local governments to organize integrated health services
so that they are more decentralized. Decentralizing authority to district or city governments in the

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health sector is related to determining authority and minimum service standards. The objectives of
determining the mandatory authority and minimum service standards are:
1) To protect public health, especially for community groups classified as poor, vulnerable
groups, and poor areas;
2) To realize the national and global commitments proclaimed by the government in carrying out
the public health insurance program.
Human resources who become implementers in health insurance carry out their duties as part ofpublic
services. Public service providers are mentioned in Article 34 of Law Number 25 of 2009 concerning
Public Services. Public service providers must have the following behavior:
1) Fair and not discriminatory;
2) Careful;
3) Polite and friendly;
4) Firm, reliable, and does not give protracted decisions;
5) Professional;
6) Do not complicate;
7) Obey legal and reasonable orders from superiors;
8) Upholding the values of accountability and integrity of the implementing institutions;
9) Not to divulge information or documents that must be kept confidential in accordance with the
laws and regulations;
10) Be open and take appropriate steps to avoid conflicts of interest;
11) Do not abuse the facilities and infrastructure as well as public service facilities;
12) Do not provide false or misleading information in response to requests for information and be
proactive in meeting the interests of the community;
13) Do not misuse the information, position, and/or obligations owned;
14) In accordance with appropriateness; and
15) Do not deviate from the procedure.
The purpose of determining public service standards that public service providers must
provide is to ensure that public service providers, including health insurance implementers, can carry
out their duties and functions. Complaints from the public regarding services from BPJS Kesehatan
providers occur in submitting applications and administering BPJS Kesehatan, which are considered
complicated by BPJS Kesehatan participants. To overcome complaints from the community
participating in BPJS Kesehatan, the government makes efforts to improve the quality of public
services in a comprehensive and integrated manner.
Human resources who carry out work as implementers of public services is the spearhead in
services that meet the expected quality standards. In the national health system, human resources in
health management are arrangements that bring together various integrated planning, education, and
training efforts to support each other and ensure the achievement of the highest possible public health.
In Government Regulation Number 32 of 1996 concerning Health Workers, health human resources
are people who work actively in the health sector, both those who have formal health education and
those who do not have formal health education and require authority in carrying out health efforts.
4. Indicators of Information Affordability in Public Services
Information that is a basic right of the community (the public) must be informed by the
government and public institutions with the authority to do so. Accessibility of information greatly
affects public services where, in substance, the management of public information is a basic right that
must be fulfilled by public institutions to be disseminated to the public. Accessibility of information is
regulated in Law Number 14 of 2008 concerning the disclosure of public information. It is stated that
public information is generated, stored, managed, and/or sent/received by a public agency related to the
administration of the state and/or the administration and administration of public bodies. Indicators of
the accessibility of information in health services can be seen from the socio-economic and educational
factors of the community. Information on health services also depends on the distance between the
community and health facilities. The spread of disease chains cannot be separated from environmental
factors where the community is located; health service providers must disseminate information about
the prevention and development of diseases that are endemic in the community. The increasing number
of BPJS Kesehatan participants describes public health status. More participants will guarantee an
increase in public health status [27].

3. Reorienting BPJS Kesehatan Services Toward Social Justice

The health insurance program must continue to be developed to achieve better health status for all
Indonesian people, and the government's obligation to develop a social security system including health

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insurance by providing health facilities and other public facilities, including health, is regulated in the 1945
Constitution of the Republic of Indonesia concerning Social Welfare [28]. BPJS Kesehatan is a program
organized by the Social Security Administering Body (BPJS). BPJS was formed on January 1, 2014. As a public
health insurance provider, BPJS participants will be able to live a decent and productive life. The main targets of
BPJS Kesehatan are as follows: Firstly, BPJS Kesehatan is expected to achieve the target of community
participation as participants of BPJS Kesehatan toward national health insurance in 2019. BPJS Kesehatan is
also expected to maintain optimal and sustainable public health. Other than that, BPJS Kesehatan is expected to
be a reliable, superior, and trusted health institution. With the programs for BPJS Kesehatan participants that the
government has designed, it is hoped that BPJS Kesehatan can provide the following benefits:
1) BPJS participants can enjoy first-level health services. First-level health services are individual
health services that include outpatient and inpatient services that can be received by BPJS
participants at health centers, Independent Practicing Doctors, Dentist Independent Practices, First
Clinics, or the equivalent of first-level health facilities owned by the TNI/Polri, Class D Primary
Hospital or medical facilities supported by the availability of pharmacies and laboratories.
2) BPJS Kesehatan participants can enjoy advanced-level referral health facility services. Advanced-
level referral health services are individual health service facilities that are specialized or sub-
specialized, including a. advanced-level outpatient services, b. advanced level inpatient services,
and c. inpatient services in special care rooms.
BPJS Kesehatan participants face several challenges in terms of services from BPJS Kesehatan
providers, including:
1) Long queues to get health services, this is due to the limited health service facilities that have
collaborated with BPJS Kesehatan;
2) The existence of rules regarding the class of inpatient rooms for BPJS Kesehatan participants
where the highest inpatient room is class 1, offset by the limited availability of rooms in health
facilities so that patients have difficulty getting inpatient rooms;
3) The limitations provided in BPJS Kesehatan services include an obstacle regarding medicines that
BPJS Kesehatan covers; BPJS Kesehatan does not cover several types of drugs, so participants
who become patients have to buy their medicines.
There are five dominant factors determining public interest in participating as BPJS Kesehatan
participants. The determining health insurance services that can attract public interest to become BPJS
Kesehatan participants are as follows:
1) Tangibles. The first factor determining the quality of health services is tangibles, which include
physical facilities, equipment for employees, or the implementation of health services and
communication facilities.
2) Reliability. Reliability is a factor of health service employees’ ability to carry out their duties to
provide services per predetermined service standards.
3) Responsiveness. The responsive factor is related to the human resource factor, which becomes the
employee implementing BPJS Kesehatan services. Health service employees are required to
provide health services quickly and responsively.
4) Assurance. The assurance factor is where health service employees can master the service products
offered to provide clear and precise information to BPJS Kesehatan participants. Sufficient
knowledge about BPJS Kesehatan service products should be provided in a polite and friendly
manner to participants to provide comfort and instill confidence in the services of BPJS Kesehatan.
5) Empathy. The empathy factor is related to the attitude of health service employees in providing
services with good communication patterns so that BPJS participants and prospective BPJS
Kesehatan users easily understand it. Empathy includes maintaining good communication
relationships and understanding customers’ needs.
When looking at the determinants of people's interest in becoming BPJS Kesehatan participants, other
factors that influence people's interest in health services are as follows:
1) Predisposing factors: these factors aim to describe people’s considerations in choosing health
services as follows:
a. Gender and age: patients' tendency to feel comfortable getting health services from the health
service providers who can provide comfort and meet patient needs.
b. Social structure of society, education, employment and social status are also factors that
influence people's choices in using health services.
c. The benefits of health services are one of the considerations in determining the choice of
health services in the hope of the patient to recover quickly from the disease.
2) Supporting factors are other benefits the participants get from health services, including financial
status, distance traveled, health service facilities, and infrastructure.

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3) The driving factor is the factor that makes it possible to find health facilities that are in accordance
with the needs of the community and the benefits are directly felt by users of health facilities.
The government's program in providing health insurance to the community, comes with the awareness
that everyone can be in a situation that can threaten their safety and health. Humans are vulnerable in dealing
with the risk of land, sea or air accidents, work accidents, natural and man-made disasters, becoming victims of
non-criminals or diseases that arise due to lifestyle or originating from congenital diseases. This is a government
concern as a mandate in running the government and the state.
Such vulnerabilities require health insurance that can be used in situations that affect the safety and
health of the community. The BPJS method is an option given by the government as a form of health insurance
facilitated by the government. Based on the system implemented in BPJS Kesehatan, compared to commercial
health insurance, BPJS Kesehatan has more complete health protection. BPJS Kesehatan covers almost all types
of diseases with various levels. BPJS Kesehatan also cooperates with private and government health facilities to
achieve the scope of services through a wider choice of healthcare facilities. BPJS Kesehatan has almost the
same pattern as commercial insurance. Still, the advantage of BPJS Kesehatan over commercial insurance is that
BPJS Kesehatan provides health care coverage for almost all types of diseases and provides health care facilities
with more choices than private commercial insurance. This is because the government requires providers of
government facilities in both districts and cities, including health centers and health clinics, to cooperate with
BPJS Kesehatan to provide broader services to the community.

III. CONCLUSION
As a state administrator, the government must provide health insurance to its citizens; therefore, the
Indonesian government regulates health insurance for the community by forming an agency to carry out this
task, BPJS. BPJS consists of two main parts of the program: BPJS Kesehatan and BPJS Ketenagakerjaan. BPJS
Kesehatan is tasked with making sure that the poor or underprivileged groups are the target recipients of health
insurance assistance from the government, as well as managing people from non-poor or general groups who
use health insurance services provided by the government. In connection with this goal, of course, it does not
necessarily solve the problems that arise in the community where two main problems arise in the BPJS
Kesehatan, namely: problems regarding the effectiveness of the implementation of BPJS Kesehatan, where
many people still complain about the effectiveness of BPJS Kesehatan services related to the health insurance.
Moreover, there are differences in the services provided by health facilities to patients who use BPJS Kesehatan
with general patients or those who use private commercial insurance. Such problems will influence the
community's interest in becoming BPJS Kesehatan participants. The level of service that does not match
expectations and the obstacles faced by BPJS Kesehatan patients become a benchmark for public interest in
becoming BPJS Kesehatan participants.

IV. ACKNOWLEDGEMENTS
The author would like to thank the Faculty of Law, Universitas Ngurah Rai, and all parts included in this
research. Sincere gratitude also goes to anonymous reviewers and editors who have provided constructive
feedback to make this manuscript worth reading and citing.

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