Benchmarking Indonesia’s Health System Against Global Standards: A WHO Framework Analysis of Reforms and Outcomes (2020–2025)
A Systematic Review of Governance, Financing, and Health Indicators
Keywords:
Indonesia Health System; Universal Health Coverage (UHC); BPJS Kesehatan; Health Financing; Health Workforce; WHO Framework.Abstract
Indonesia has undertaken one of the world’s most ambitious health system reforms through the implementation of the Jaminan Kesehatan Nasional (JKN), managed by BPJS Kesehatan. While the country aims for Universal Health Coverage (UHC), persistent disparities remain. This study benchmarks Indonesia’s health system performance against 2025 global standards using the World Health Organization (WHO) framework, focusing on governance, financing, workforce infrastructure, and health outcomes. A systematic descriptive-analytical review was conducted according to PRISMA guidelines. Secondary data from 2020 to 2025 were synthesized from the WHO Global Health Observatory, World Bank Open Data, and Indonesian Ministry of Health reports. Fifty primary studies and policy documents were analyzed to evaluate key indicators against global or regional peer benchmarks. Findings indicate a dichotomy between coverage expansion and system capacity. Indonesia has achieved nominal universal coverage for over 84% of its population (approximately 222 million people), with the Penerima Bantuan Iuran (PBI) scheme successfully shielding over 1 million individuals from poverty. However, structural deficits persist: (1) Financing: Health expenditure stands at 3.1% of GDP, significantly below the global average of 6%, with high out-of-pocket (OOP) spending at 31% (benchmark: <20%). (2) Workforce: There is a critical shortage of human resources, with a physician density of 0.4 per 1,000 population (global benchmark: 1.8) and a hospital bed ratio of 1.2 per 1,000 (global average: 2.9). (3) Outcomes: While life expectancy has reached 72.5 years, maternal mortality (177 per 100,000 live births) remains substantially higher than the Sustainable Development Goal (SDG) targets, reflecting gaps in service quality and equitable access across the archipelago. Indonesia has successfully established a massive single-payer framework, yet the transition from "nominal coverage" to "effective coverage" faces significant bottlenecks. To align with 2025 global standards, the system requires an expanded fiscal space, aggressive implementation of the 2023 Omnibus Health Law to address workforce maldistribution, and a strategic shift from curative to preventive primary care
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