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 Extension of Social Security Coverage to

 Informal Economy Sector

The roots of current form of social insurance in the I.R. Iran goes back to 1930 which was established under the title of Workers Provident Fund  which became organized in 1975 in the form of Social Security Organization  .

Currently, the SSO as the greatest social insurance body, medical network and pension fund in the region has covered around 40 million persons. 

One form of quality management is cost-efficiency. In term of cost-efficiency,  BPJS Kesehatan is developing a referral system. Fasilitas Kesehatan Tingkat Pertama (FKTP) acts as a gate keeper for the selection of cases that can treated at the first or second level of health care. Of course this is very important for the aspect of financing, because the cases handled by the second level of health care cost more. The fact is that 144 diagnoses that should be completed in FKTP were still referred to second level health care facilities.

In the implementation of the Indonesian Social Health Insurance (called JKN), that had been started on 1^st of January 2014 based on the Health Ministry Regulation No. 69/2013 about health care payment standard that increased the capitation cost from Rp. 2.000 to Rp. 6.000,-. ( Rp 400 million to Rp 1.2 billion per month - USD 31 thousands to USD 93 thousands).

BPJS Kesehatan (Badan Penyelenggara Jaminan Sosial Kesehatan) is a public agency established to implement the social security programme. The ultimate vision of BPJS Kesehatan is "Universal Health Coverage"; to provide all participants with health care benefits and protection to meet the basic needs of health care. As Indonesia is fourth most populous country in the world there are a large number of participants, so BPJS Kesehatan is facing constraints in the participants' registration process.

In an archipelago country like Indonesia, the financial barrier is not the only barrier to healthcare access, but also the socio-geographical barrier. Health facilities are distributed unevenly throughout the nation, where hospitals are only available at the district level. The lack of infrastructure to reach the hospitals is another challenge for rural patients to receive treatment. On the other hand, there are sufficient numbers of primary healthcare facilities in the rural areas, which are not utilized optimally.