Analysis of Determinant Factors in the Provision of Group Health Insurance by Employers in the Context of National Health Insurance Implementation in Indonesia

Abstract

Indonesia’s National Health Insurance (Jaminan Kesehatan Nasional or JKN) is a mandatory social health insurance program aimed at achieving universal health coverage in Indonesia. Although all formal workers are required to be enrolled in JKN, many companies continue to provide commercial group health insurance or private health insurance (PHI) for their employees. This phenomenon indicates the coexistence of a social health insurance system and a commercial health insurance system that requires further understanding. This study aims to analyze the factors influencing employers’ decisions to continue providing PHI amid mandatory JKN participation, as well as to understand the relationship between the two systems.This study used a mixed-method approach with qualitative dominance. Primary data were obtained through in-depth interviews with informants from employer groups, insurance companies, and insurance brokers. Secondary data were obtained through an analysis of JKN regulatory documents, as well as group health insurance policy and claims data. Primary data were analyzed using thematic analysis, while secondary data were analyzed descriptively and comparatively.The results show that employers’ decisions to provide PHI are influenced by three main groups of factors: institutional factors, insurance product characteristics, and corporate strategies and objectives. Institutional factors include regulatory pressure, employee expectations, and industry practices. Insurance product characteristics include differences in benefit coverage, service access, service quality and convenience, administration, and benefit flexibility between JKN and PHI. Corporate strategic factors relate to efforts to improve productivity, attract and retain talent, and strengthen the employee value proposition.The findings show that PHI is perceived as a complement to JKN because it provides added value through improved access, flexibility, and healthcare service experience. The Coordination of Benefits mechanism (Koordinasi Antar Penyelenggara Jaminan or KAPJ) has the potential to strengthen the complementary relationship between JKN and PHI through more integrated financing coordination. This study concludes that the provision of PHI by employers is not merely a response to the limitations of JKN, but also part of an organizational strategy in human resource management and value creation for employees.