By Agnes Salyanty & Maria Serenade Sinurat
One morning in Might 2022, Susanti (41), awakened with a pointy ache in her abdomen. At first, she thought she was pregnant. However after an ultrasound, she acquired devastating information: a tumor was rising inside her. She instantly turned to BPJS Kesehatan, Indonesia’s Nationwide Well being Insurance coverage program, for therapy. The surgical procedure was profitable, and BPJS coated the fee. However the bills didn’t cease there. She nonetheless needed to pay further out-of-pocket prices for medicine and colostomy baggage, which needed to be ordered from exterior the island. The prices rapidly added up. Throughout this tough time, her household stepped in to assist her handle the monetary burden.
Susanti’s story is one in every of many. For low-income girls, entry to healthcare generally is a problem. In Ladies’s World Banking’s newest report, Unpaid, Underserved, Unprotected: Fixing the Healthcare Financing Hole for Indonesian Ladies, we discovered that whereas BPJS now covers 98.45% of Indonesia’s inhabitants, almost 20% of enrollees stay inactive, as many wrestle with monetary constraints, lack of expertise, or difficulties navigating the system.
The unseen value of restricted healthcare entry
Ladies bear a heavier healthcare burden than males. Their medical wants are better, but they’ve fewer monetary assets. For 16.7% of girls, maternal healthcare alone consumes over 5% of their annual family revenue. Ladies-headed households are most affected, spending 71% of their non-food price range on public hospital care and 112% on non-public hospitals.
With such excessive prices, many ladies spend much less on their very own healthcare—not as a result of they want it much less, however as a result of they merely can’t afford it. Nonetheless, the problem goes past affordability; it’s additionally about how the system is designed. Specialist providers, diagnostic exams, and non-generic medicines typically require further out-of-pocket funds. Being pregnant ultrasounds, persistent illness remedies, and even emergency care will be expensive. Confronted with these bills, girls typically make tough decisions: delaying or skipping obligatory care, borrowing cash, or promoting valuables to cowl prices. Non-public insurance coverage might assist, however it stays out of attain for a lot of.
Novalia, a 22-year-old mom of two in Jayapura, is among the many many ladies affected by insufficient healthcare protection. Throughout her second being pregnant, she found that the native well being middle didn’t have an ultrasound machine, and nobody supplied her a referral. Although she was coated by BPJS, she nonetheless needed to pay Rp 900,000 for 3 ultrasounds past protection. To afford it, she offered her earrings. “Generally, promoting jewelry was the one fast resolution. My husband didn’t need me to do it, however it was the one choice we had,” she mentioned.
Novalia additionally paid out of pocket for her kids’s medicines and their first go to to the Puskesmas. Her expertise illustrates how gaps within the well being system—mixed with restricted monetary choices—can go away girls shouldering the hidden prices of maternal care on their very own.
A college scholar and mom of two, she runs a small meals enterprise from the home she shares with seven members of the family.
Making healthcare financing work for girls
No lady ought to have to decide on between her well being and monetary safety. A stronger, extra versatile healthcare system can guarantee girls get the care they want with out monetary pressure. Right here’s how change can occur.
Bringing monetary literacy into healthcare
Many ladies assume BPJS covers all medical prices, solely to be stunned by further out-of-pocket bills. With out monetary planning, they wrestle to pay for specialist care, medicines, or maternity providers. Healthcare amenities can do greater than present therapy; they may also help girls put together for medical bills.
Midwives, Puskesmas, and hospitals can introduce girls to monetary planning instruments and assist them perceive BPJS advantages, non-public insurance coverage, and financial savings choices. Neighborhood teams additionally play a key function in making monetary literacy extra accessible in day by day life.
However consciousness alone isn’t sufficient; it takes collaboration. The Ministry of Well being, OJK, and BPJS Kesehatan can work collectively to develop nationwide monetary literacy packages that make well being financing simpler to navigate. On the identical time, the Ministry of Finance can introduce incentives to encourage monetary planning for healthcare via public schooling and digital platforms.
When well being, finance, and schooling align, girls are usually not simply knowledgeable; they’re ready. With the fitting assist, they will entry healthcare with out worry of economic hardship
Making BPJS extra versatile via higher coordination
Even with monetary literacy, girls want a system that works for them. Presently, BPJS and personal insurance coverage coordination will not be seamless, making it tough to cowl prices effectively. A well-designed Coordination of Advantages (CoB) system would enable girls to mix BPJS and personal insurance coverage to scale back monetary gaps. However unclear guidelines and sophisticated processes make this tough for hospitals and insurers.
To alter this, the Ministry of Well being wants to determine clear cost-sharing guidelines and BPJS Kesehatan must simplify claims processing. Pilot packages in city and rural areas can take a look at enhancements earlier than rolling them out nationwide. A centralized digital system would additionally velocity up claims and scale back paperwork.
Increasing reasonably priced well being financing via public-private partnerships
Even with BPJS, many ladies wrestle to afford healthcare. These with irregular incomes want extra versatile fee choices, comparable to well being financial savings accounts and microinsurance with small, frequent premiums. Midwives, as trusted healthcare suppliers, can introduce girls to those monetary instruments, whereas partnerships with fintech and banks could make them accessible.
One profitable instance is the partnership between Ladies’s World Banking, Financial institution Negara Indonesia (BNI), and the Indonesian Midwives Affiliation. By coaching midwives as banking brokers, this system helped pregnant girls open well being financial savings accounts at clinics. This allowed them to step by step save for the prices of childbirth, lowering monetary stress and strengthening the financial function of midwives. Increasing such fashions would assist extra girls entry care with out monetary hardship.
Revolutionary financing for casual staff
Many ladies within the casual sector have unpredictable incomes and no well being advantages. With almost 60% of Indonesia’s workforce in casual jobs, healthcare prices generally is a heavy burden. Conventional insurance coverage fashions typically fail to satisfy their wants.
Monetary providers suppliers may also help by embedding installment funds, micro well being financial savings, and pay-later choices into digital wallets and neighborhood financial savings platforms, making it simpler for girls to avoid wasting in small, manageable quantities. Cooperatives, unions, and digital work platforms may assist group-based financing, serving to casual staff entry collective well being plans with decrease premiums and higher protection. Increasing these fashions might make healthcare extra reasonably priced, accessible, and sustainable for uninsured and underinsured staff.
Investing in girls’s well being financing has a ripple impact far past the person. It strengthens households, communities, and economies. Eradicating monetary boundaries is simply step one; actual change comes from embedding options that guarantee girls’s well being safety at each stage. A really inclusive, women-centered method isn’t simply an choice. It’s the muse for designing insurance policies and monetary providers that supply long-term safety and assist a resilient future for girls.