By Agnes Sacralty & Maria Sereen Write
One morning in Could 2022, Susanti (41), wakened with a pointy ache in her abdomen. At first, she thought she was pregnant. However after an ultrasound, she obtained 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 lined the associated fee. However the bills didn’t cease there. She nonetheless needed to pay further out-of-pocket prices for remedy and colostomy luggage, 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 all many. For low-income ladies, 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 battle with monetary constraints, lack of information, or difficulties navigating the system.
The unseen price of restricted healthcare entry
Ladies bear a heavier healthcare burden than males. Their medical wants are higher, but they’ve fewer monetary assets. For 16.7% of girls, maternal healthcare alone consumes over 5% of their annual family earnings. Ladies-headed households are most affected, spending 71% of their non-food finances on public hospital care and 112% on personal 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. Nevertheless, the problem goes past affordability; it’s additionally about how the system is designed. Specialist providers, diagnostic assessments, and non-generic medicines typically require further out-of-pocket funds. Being pregnant ultrasounds, power illness therapies, and even emergency care will be pricey. Confronted with these bills, ladies typically make tough decisions: delaying or skipping mandatory care, borrowing cash, or promoting valuables to cowl prices. Personal insurance coverage may assist, but it surely 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 heart didn’t have an ultrasound machine, and nobody provided her a referral. Though she was lined by BPJS, she nonetheless needed to pay Rp 900,000 for 3 ultrasounds past protection. To afford it, she offered her earrings. “Typically, promoting jewelry was the one fast resolution. My husband didn’t need me to do it, but it surely was the one possibility we had,” she stated.
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 depart ladies shouldering the hidden prices of maternal care on their very own.
A college pupil and mom of two, she runs a small meals enterprise from the home she shares with seven relations.
Making healthcare financing work for ladies
No lady ought to have to decide on between her well being and monetary safety. A stronger, extra versatile healthcare system can guarantee ladies 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 battle to pay for specialist care, medicines, or maternity providers. Healthcare amenities can do greater than present therapy; they can assist ladies put together for medical bills.
Midwives, Puskesmas, and hospitals can introduce ladies to monetary planning instruments and assist them perceive BPJS advantages, personal insurance coverage, and financial savings choices. Neighborhood teams additionally play a key function in making monetary literacy extra accessible in every day life.
However consciousness alone isn’t sufficient; it takes collaboration. The Ministry of Well being, OJKand BPJS Well being can work collectively to develop nationwide monetary literacy packages that make well being financing simpler to navigate. On the similar time, the Ministry of Finance can introduce incentives to encourage monetary planning for healthcare by means of public training and digital platforms.
When well being, finance, and training align, ladies will not be simply knowledgeable; they’re ready. With the precise help, they’ll entry healthcare with out concern of monetary hardship
Making BPJS extra versatile by means of higher coordination
Even with monetary literacy, ladies want a system that works for them. Presently, BPJS and personal insurance coverage coordination shouldn’t be seamless, making it tough to cowl prices effectively. A well-designed Coordination of Advantages (CoB) system would permit ladies to mix BPJS and personal insurance coverage to cut back monetary gaps. However unclear guidelines and sophisticated processes make this tough for hospitals and insurers.
To vary 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 inexpensive well being financing by means of public-private partnerships
Even with BPJS, many ladies battle to afford healthcare. These with irregular incomes want extra versatile fee choices, similar to well being financial savings accounts and microinsurance with small, frequent premiums. Midwives, as trusted healthcare suppliers, can introduce ladies 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 ladies open well being financial savings accounts at clinics. This allowed them to progressively save for the prices of childbirth, decreasing monetary stress and strengthening the financial function of midwives. Increasing such fashions would assist extra ladies entry care with out monetary hardship.
Modern financing for casual employees
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 can assist 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 ladies to avoid wasting in small, manageable quantities. Cooperatives, unions, and digital work platforms also can help group-based financing, serving to casual employees entry collective well being plans with decrease premiums and higher protection. Increasing these fashions may make healthcare extra inexpensive, accessible, and sustainable for uninsured and underinsured employees.
Investing in ladies’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 ladies’s well being safety at each stage. A really inclusive, women-centered method isn’t simply an possibility. It’s the inspiration for designing insurance policies and monetary providers that supply long-term safety and help a resilient future for ladies.
