Indonesia’s Healthcare Revolution: Eliminating Tiered JKN for Patient-Centric, Competency-Based Referrals

Indonesia is embarking on a pivotal transformation of its National Health Insurance (JKN) scheme. The government has announced ambitious plans to phase out the existing tiered referral system and replace it with a new model centered on competency-based referrals.

This is not just an administrative tweak—it’s a fundamental shift designed to put the patient’s immediate clinical needs first.

The Inefficiency of the Old Tier System

The current tiered referral system, which classifies hospitals into A-D classes, often forces patients on a multi-step journey between facilities. As explained by Dr. Obrin Parulian, Director of Clinical Services at the Health Ministry (Kemenkes), this hierarchy frequently leads to:

• Prolonged treatment times: Patients waste critical time moving between facilities.
• Worsened medical conditions: Delays in reaching the right specialist can be detrimental.
• Financial inefficiency: Increased patient transfers drive up overall system costs.

This outdated process, driven by administrative tiers rather than clinical capacity, no longer aligns with the goals of universal healthcare coverage.

The Shift to Competency: SatuSehat and Clinical Focus

The new model is designed to be direct and clinical. By leveraging the SatuSehat Referral platform, the process becomes automated and patient-focused:

1. Clinical Input: The referring physician enters the patient’s diagnosis and required procedures into the system.
2. Competency Matching: The platform instantly directs the JKN participant to a hospital that is competent and equipped to handle that specific medical condition and procedure.
3. Digital Intelligence: This system is integrated with real-time data, including geotagging and bed availability through the inpatient information system (Siranap). If the preferred, competent facility is full, the system automatically finds the next suitable option with equal or higher competency.

This change accelerates patient access and ensures the highest quality of service is delivered without unnecessary transfers.

Benefits and The Road Ahead

The Kemenkes anticipates several significant benefits from this transition, targeting full implementation by early 2026:

• Enhanced Quality of Care: Patients receive specialized care immediately from facilities that are clinically proven to provide it.
• Improved Efficiency: Ahmad Irsan, Head of the Health Financing Center, noted that while initial simulations show a minor increase in fund expenditures (0.64% to 1.69%), the expected reduction in costly patient transfers will ultimately improve financing efficiency.
• Digitalized Healthcare: The integration of the SatuSehat platform establishes a robust, modern digital backbone for the JKN scheme.

This referral transformation is also running in parallel with the acceleration of the Standard Inpatient Class (KRIS) implementation, ensuring that clinical service standards across all participating hospitals are uniformly high.

A Call for Preparation

The move towards competency-based referrals signifies Indonesia’s commitment to a more effective, patient-centric universal healthcare system. For hospital administrators, clinicians, and health tech providers, the transition to early 2026 demands immediate action:

• Hospitals: Verify and document your full clinical competencies and ensure seamless integration with the SatuSehat/Siranap platforms.
• Clinicians: Prepare to utilize the digital referral system to make faster, more accurate decisions based on clinical capability.

This shift in the National Health Insurance (JKN) system represents a critical inflection point for medical businesses looking to enter the Indonesian market. The move from a geographic/administrative-based tiered system to a competency-based referral model fundamentally changes the rules of engagement.

For new entrants from specialized hospitals to digital health providers, this means that verifiable clinical excellence and digital preparedness are now the primary determinants of market access and revenue flow, rather than just capital investment or location.

1. Implications for Market Entry in Medical Business

The competency-based system creates both significant challenges and opportunities for foreign and new medical businesses:

The key takeaway is that new businesses can bypass the traditional slow climb through the tiers by immediately establishing a high level of specialized clinical competence that Indonesia currently needs.

2. Strategic Shifts for New Entrants

A. Clinical Excellence is Non-Negotiable

The new system is designed to match the patient’s clinical needs directly to the hospital’s competency. This means new entrants cannot afford a gradual build-up of capability; they must:

• Target Niche Specializations: Instead of building a general hospital, focus on centers of excellence (e.g., advanced rehabilitation, specific oncology treatments) where the demand and clinical gap are highest.
• Gain Immediate Accreditation: Secure international or national certifications that quickly validate their specialized capabilities to the government and referring physicians.

B. Digital Interoperability is the Gateway

The SatuSehat Referral platform is the engine of the new system. It automatically matches patient needs to hospital availability and competency. For a new business, this platform is the primary mechanism for receiving JKN patients.

• Integration from Day One: Your hospital/clinic’s IT infrastructure must be designed for seamless, real-time integration with SatuSehat and the inpatient information system (Siranap), which tracks bed availability.
• Data Quality: Accurate, real-time input regarding your clinical capabilities and service capacity is crucial, as the system relies on this data for automatic referrals.

C. Adhering to the Standard Inpatient Class (KRIS)

Simultaneously, the government is accelerating the implementation of KRIS standards. Any new hospital seeking JKN participation must factor these physical standards into their facility design and operating budget upfront. This includes specific requirements for:

• Nurse call systems.
• Oxygen outlets per bed.
• Non-porous curtains.
• Accessible bathrooms.

Meeting these standards is a prerequisite for inclusion in the overall quality improvement and referral framework.

3. Mandatory Preparations for Market Entry

To successfully enter the Indonesian healthcare market under the new JKN rules, medical businesses must take the following steps:

1. Verify Demand and Competency Gaps:
   • Conduct thorough market research to identify specific high-demand, high-cost clinical areas where local competency is lacking (e.g., complex surgery, advanced diagnostics).
   • Ensure your proposed service mix directly addresses these documented gaps.
2. Build a Future-Proof Digital Backbone:
   • Allocate capital for a Health Information System (HIS) that is SatuSehat-compliant and capable of real-time data exchange with government platforms.
   • Appoint a Chief Information Officer (CIO) or technology lead with expertise in Indonesian health informatics standards.
3. Design for KRIS Compliance:
   • In the planning and construction phase, ensure the physical hospital design meets all KRIS standards to avoid costly retrofitting later.
   • Factor in the cost of high-quality equipment and medical staff necessary to achieve specific accreditations.
4. Strategic Local Partnerships:
   • Engage early with local Primary Health Care Centers (Puskesmas) and primary care physicians. While your facility may be a secondary or tertiary hospital, these local providers are the first point of contact and the key referral source.
   • Establish relationships with the Health Ministry (Kemenkes) to ensure your facility’s planned competencies are properly registered and recognized by the new system.