Pengaruh Pengembangan Jaminan Kesehatan Bali Mandara terhadap Keberadaan Jaminan Kesehatan Tingkat Kabupaten di Bali dan Upaya Pencapaian Universal Coverage

Background: To conduct an analysis of the influence of the Bali Mandara Health Insurance (JKBM) policy concerning the existence of district level health insurance and its impact on achieving universal coverage. Method: Literature review to produce an analysis of JKBM policy and to produce appropriate policy alternatives for financing and health care issues which emerged from the implementation of JKBM. Results: The aim of Bali Mandara Health Insurance is to provide health services which are fully subsidized by the Provincial and Districts Government in Bali. JKBM is intended for peoples who do not protected by health insurance programs. The implementation of JKBM has forced Tabanan to stop the Askes Mandiri program while Jembrana District decided not to take part in JKBM. Unlike JKJ and Askes Mandiri, JKBM is still managed by a coordination team under Bali Health Office Supervision. Furthermore another fundamental difference is regarding on how they finance the program. JKBM is fully financed from sharing subsidies while JKJ and Askes Mandiri are financed from member premium. Nevertheless JKBM policy is potential to expand the efforts of achieving universal coverage, improve equity in health financing and fulfil a non-profit principle of social health insurance. Along with the positives impact, this program also has several weaknesses. One of the weaknesses is lack of consideration to the principles of social solidarity and mutual cooperation. Communities’ participation in health financing program which has been developed by JKJ and Askes Mandiri is abandoned. In addition to these weaknesses JKBM also less able to adopt the district health insurance who have first evolved. JKJ case shows of JKBM failure to apply the principle of portability and benef its coordination of the services thereby potentially harming the people of Bali. Conclusion: Bali provincial government should immediately develop Implementing Agency (Badan Pelaksana) of JKBM to organize and develop the program. In addition to this, member participation throughout premium payment could be established gradually to ensure the sustainability of the program. JKJ and JKBM should operate in harmony by considering role distribution between member, Provincial Government of Bali, and Government of Jembrana. Keywords: health insurance and universal coverage