Research Topics

Publications

The U4 Blog

Learning & events

About Us

U4 Issue

Tackling fraud and corruption in Indonesia’s health insurance system

Indonesia’s National Health Insurance programme was established in 2014 to promote universal health coverage and currently covers 82% of the population. However, the programme has run large deficits, partly because of corruption and fraud. Current regulatory approaches to minimising corruption in the programme are not working well. Stakeholders need more knowledge and resources to implement anti-fraud strategies based on a thorough assessment of the various risks.

3 November 2022
Download PDFRead short version

Main points

  • Since its creation in 2014, Indonesia's National Health Insurance programme (JKN) has had a positive impact on access to health care, even though it is underfunded. Addressing corruption is crucial in order to safeguard the funds available.
  • Fraud in national health insurance schemes can include billing for services not rendered, unnecessary medical tests and treatments, kickbacks, third-party fraud, and bribery, among others.
  • Fraud and corruption in the JKN programme cause significant financial losses and decrease health care quality and access.
  • During the Covid-19 pandemic, the risk of fraud and corruption increased due to uncertainty and disruptions arising from the emergency. These allowed different actors to take advantage of the situation for private gain.
  • Despite some progress in addressing fraud and corruption, efforts to strengthen measures at the central and subnational levels remain inadequate and have not been implemented optimally. This is due in part to lack of clarity on responsibilities and an absence of clear guidelines on fraud risk management.
  • Future interventions should be based on a thorough fraud risk assessment as the basis for targeted and feasible measures to mitigate fraud and corruption risk.

Cite this publication


Susanti, D.; Arifin, P.; Rahma, D.; Fahmi, M.; Julaeha, L.; Putri, W.; (2022) Tackling fraud and corruption in Indonesia’s health insurance system. Bergen: U4 Anti-Corruption Resource Centre, Chr. Michelsen Institute (U4 Issue 2022:13)

Download PDFRead short version
Dwi Siska Susanti
Pauline Arifin
Drg. Puti Aulia Rahma
Mohammad Fahmi
Linda Julaeha
Wibi Anska Putri

Disclaimer


All views in this text are the author(s)’, and may differ from the U4 partner agencies’ policies.

This work is licenced under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND 4.0)

Keywords


accountability, governance, health sector, Indonesia