BPJS Kesehatan is the largest health insurance provider in the world, serving 201 million people in 2018 (80% of Indonesia’s population). In January 2014, BPJS Kesehatan transformed from a state-owned company (PT Askes) with 16 million members into a service suddenly responsible for 121 million people. BPJS Kesehatan has over 7,000 employees, yet this is still not enough to serve the huge number of people requiring their services. This led to the innovation of creating a mobile application.
The National Health Insurance program (referred to as JKN) is managed by BPJS Kesehatan, determined as such by Law number 24/2011. It aims to provide health insurance to all Indonesian residents. By 1 September 2018, 201.6 million people were already registered as JKN participants. Based on Law no 40/2004 on the National Social Insurance System, BPJS Kesehatan must achieve universal health coverage by 2019; this means an effective time period of just five years. In 2014, 121 million Indonesians already had health insurance through the scheme, with a goal of 250 million participants by 2019. Originally, most participants were from similar backgrounds (civil servants, police, armed forces) but now are more varied.
When BPJS Kesehatan began operating, the Indonesian population was very enthusiastic and quickly began enrolling in the program, updating their data, their insurance history, and giving feedback/complaints. This led to long queues at many BPJS Kesehatan offices, with an average of just under 300,000 people visiting the offices every day. This caused inconvenience for participants and led to a drop in user satisfaction survey results, especially in indicators such as responsiveness, speed, and complaint handling. Over the course of three years beginning in 2014, the user satisfaction survey did not meet its target, falling from 81% in 2014, to 78.9% in 2015, and 78.6% in 2016.
This led to BPJS Kesehatan developing a mobile application based on web service called Mobile JKN that can be accessed anywhere and at any time by users. Mobile JKN makes accessing services much easier – participants can register, update personal information, retrieve insurance information, look up premiums needing to be made, register for appointments at health facilities, ask questions about the program, and submit complaints.
Mobile JKN also has an effect on BPJS Kesehatan itself. It has increased efficiency through ensuring that no new offices need to be established or additional staff employed; reducing the amount of paper and electricity used; and reducing transportation costs. Evaluation results of the app’s use have shown that the number of participants visiting BPJS Kesehatan offices fell by 68.5% and user satisfaction increased by 0.9% at the end of 2017.
What Makes Your Project Innovative?
Since the beginning of the National Health Insurance Scheme (JKN) in 2014, the number of participants has grown significantly. However, this growth has not be matched by a similar growth in human resources or facilities. BPJS Kesehatan offices are open only eight hours a day, Monday to Friday, and there are insufficient customer service staff and service kiosks, leading to less than optimal services. Additionally, some health facility workers do not understand JKN and its administrative requirements, meaning that users feel the bureaucracy is overly complicated and too much legwork falls on them.
With the JKN Mobile app, administrative services can now be accessed online at any time and from any place. Users of JKN can also obtain medical services at health facilities by simply showing their digital card in the app – they do not need to bring the physical card any more. Thus the whole process is now digital, from registering for the insurance through to using it.
What is the current status of your innovation?
With the restructuring of the private company PT Askes to become BPJS Kesehatan, huge changes took place in people, processes, and tools. Human resources were reduced; business processes were decreased from 1,700 to 833; and innovations in tools were developed to automate services, such as the Mobile JKN app.
Mobile JKN has now been implemented for four years and continues to be updated and improved daily. Visits to BPJS Kesehatan offices have decreased by 68.5% and user satisfaction has increased 0.9% from 2016 to 2017. Users can now also access their medical treatment history through Mobile JKN, and BPJS Kesehatan hopes the app could become the single platform for all patients and health facilities throughout Indonesia.
Collaborations & Partnerships
In developing Mobile JKN, collaboration between stakeholders was required to ensure that BPJS Kesehatan can provide health insurance as legally obliged. Citizens provide feedback on BPJS Kesehatan and individual health facilities. Ministry of Home Affairs validates user data and ensures participants are eligible. Ministry of Communication & Information raises awareness. Companies encourage employees to join BPJS Kesehatan. Banks provide services for users to pay their premiums through the app.
Users, Stakeholders & Beneficiaries
The Ministry of Home Affairs was able to improve its data on Indonesian citizens, thanks to enquiries from users of Mobile JKN. Citizens gained new knowledge of their correct citizenship data because they were required to register through Mobile JKN.
Results, Outcomes & Impacts
1. Increase in user satisfaction index
After introducing Mobile JKN, user satisfaction increased from 78.6% to 79.5% between 2016 and 2017, according to a survey of users.
2. Decrease in number of users visiting BPJS Kesehatan offices
After the grand launching of Mobile JKN, the average number of users visiting the BPJS Kesehatan offices every day to obtain services fell from 298,593 to just 94,542 (a drop of 68.5%).
3. Increase in services available through Mobile JKN
Many features have been added to the app since it was launched, thanks to the enthusiasm of users. Now over 2.6 million people have downloaded and registered on the app, with just under 2 million active users.
4. Increase in responses to user complaints
In August 2018, 2,623 complaints were submitted by users through Mobile JKN. 98.69% were deemed ‘complete’ within the five day maximum working range.
Challenges and Failures
The biggest challenges, and those which may cause the entire innovation to fail, include a range of factors. One is Indonesia’s geography: being an archipelago leads to difficulties in infrastructure such as internet access, especially in rural areas. Another is that the app must be constantly maintained and updated so that users remain engaged and active. Thirdly, it can be said that the middle and lower classes of Indonesia are not yet used to using technology to assist them in their everyday lives. Fourth, the type of device (smart phone) required to download and use Mobile JKN is a challenge. The final challenge is the user registration target of 10 million, to be achieved by the end of 2018, whereas the current number of users is just 2.6 million.
Conditions for Success
Things supporting Mobile JKN’s success include cooperation between stakeholders; routine maintenance and improvement of the app; large-scale awareness raising campaigns to encourage citizens to use the app; competitions both internal and external to increase the rate of registration and use of Mobile JKN; media coverage of Mobile JKN through all forms of media and public information sources, working with the Ministry of Communication and Information.
Mobile JKN has become a single platform for three stakeholders: participants, health facilities, and BPJS Kesehatan. Mobile JKN has put for an example of a public service that is transparent, easily accessible in real time, and can be replicated by other public service providers such as National Electricity Company and Telecommunication Company. This is important because if public services are slow or of poor quality, this will have a negative impact on users’ trust towards the provider. An innovation like Mobile JKN greatly helps us to reduce the number of visitors to BPJS Kesehatan offices and makes it simpler for patients when seeking treatment at health facilities, making services more effective and efficient. BPJS Kesehatan is optimistic that this innovation will be adopted by other countries that are also newly introducing and implementing social and health insurance programs so that their programs can become high-quality, fast, and transparent, too.
Based on our experiences implementing Mobile JKN, we believe there are a number of useful lessons learned:
1. Mobile apps are able to successfully fulfill the needs of users without them having to visit offices to register, obtain services, make payments, and submit complaints.
2. Mobile apps are able to reduce queue lengths and waiting times at service offices. This could be easily replicated to other public service providers.
3. In the digital era, IT acts not just as a supporter but rather an enabler to achieve business aims and develop a competitive edge.
4. In order to develop a useful innovation, knowledge of the environmental conditions (internal and external) is required so that the innovation can achieve its goals.
5. Investing in IT can be seen as too expensive, but the value it provides to service providers and users outweighs this.
6. The top management must be aware of and fully support the innovation to ensure it is implemented successfully.
We have some recommendations we would like to put forward:
1. Additional evaluation of the app and how its users use it is required, to ensure that in the future we can improve the app to make it in line with user expectations.
2. To improve health services, in developing the Mobile JKN app, BPJS Kesehatan made significant use of best practice information on mobile health.
a very good application solution for public services in Indonesia and can be used by countries in the world