This regulation was welcomed by various healthcare industry players, especially private insurance companies and hospitals as healthcare facility providers. The provision of cost-sharing through the new Coordination of Benefit (CoB) scheme will provide greater opportunities for supplementary healthcare insurance providers (private insurance) to play a greater role in providing access to public health services.

For hospitals, the new CoB scheme allows them to obtain better payment and profitability compared with the previous scheme due to the restriction of class increases and a cap on the Indonesia Case-Based Groups (INA CBG) rate. Meanwhile, JKN participants, especially the middle and upper segments (class 2 and 1 membership), can better utilize the JKN program according to their needs for better facilities and convenience.

However, despite these opportunities, there are several challenges that arise, such as a lack of technical regulation for the implementation, the possible need to adjust the terms of insurance policies, which currently vary according to the product, and if they are to cover the difference in costs for JKN participants and so on.

The CoB scheme allows users to combine the JKN with out-of-pocket (self-pay) payments or payments from employers and/or private insurance companies to access better medical services than the initial entitlement obtained according to the class of membership in JKN.

There are several changes in the provisions of the cost difference in the latest CoB scheme according to Permenkes No. 3 of 2023 compared with the previous scheme in Permenkes No. 51 of 2018.

First, the new regulation allows upgrades of more than one tier class above a JKN user’s membership class entitlement. Formerly, users were only allowed to upgrade one tier class above their membership class entitlement. In the case of JKN participants upgrading from class 2 to a class above class 1 (more than one tier class), the difference in costs paid is the difference in INA-CBG rates between class 1 and class 2 plus a maximum of 75 percent of the INA-CBG rate for class 1.

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