Strengthening the Sustainability of Indonesia's National Health Insurance Through Promotive and Preventive Care Penguatan Sustainabilitas Jaminan Kesehatan Nasional Berbasis Layanan Promotif dan Preventif di Indonesia

Abstract

This study analyzes the urgency of reorienting BPJS Kesehatan policy from a predominantly curative approach toward promotive and preventive strategies within Indonesia’s health system. Despite the significant increase in national health expenditure, financing remains largely dominated by curative services, particularly hospital care and the treatment of catastrophic diseases, contributing to rising fiscal pressures and inefficiencies. This condition reflects a misalignment between the fundamental objective of health insurance, maintaining a healthy population and its current implementation, which still focuses on treating illness. Using a qualitative method with a literature review approach, this study draws on national policy documents, academic journals, and reports from official institutions. The findings show that strengthening upstream interventions through health promotion, disease prevention, and early detection can significantly reduce morbidity rates and long-term healthcare costs. Structural challenges persist, including the unequal distribution of health workers, a low doctor-to-population ratio, and limited integration of preventive services within the financing system. Therefore, comprehensive health sector reform is required, including strengthening primary healthcare, integrating promotive and preventive programs into BPJS financing, improving public health literacy, and introducing incentive-based mechanisms for healthcare providers. Ultimately, a balanced integration of upstream and downstream approaches is essential to achieving an efficient, equitable, and sustainable health system in Indonesia