Policy Implementation Gaps in Indonesia’s National Health Insurance Contribution Assistance Program: A Qualitative Study in Merauke

Abstract

Achieving universal health coverage through the National Health Insurance (JKN) program depends not only on expanding enrollment but also on the quality of policy implementation at the local level. The Premium Assistance Program (PBI) is designed to ensure health protection for the poor and vulnerable, yet its implementation still faces various administrative and institutional challenges. This study aims to analyze gaps in the implementation of the PBI-JKN program in Kelapa Lima Village, Merauke District, using the four dimensions of implementation proposed by Edwards III: communication, resources, disposition, and bureaucratic structure. The study employed a qualitative descriptive approach with six institutionally-based informants selected through purposive sampling. Data were collected through in-depth interviews, observations, and documentation, and were subsequently analyzed through data organization, coding, the development of categories and themes, and triangulation. The results indicate that the PBI-JKN program is operational at the local level but has not yet been fully optimized. Gaps primarily arise in the speed and consistency of information, updating beneficiary data, technical capabilities, administrative completeness, limitations on authority, and interagency coordination. The disposition of implementers is relatively supportive; however, this commitment has not yet been fully able to overcome the system’s limitations. Across all dimensions, data governance and interagency coordination are critical mechanisms that influence the accuracy of targeting and the responsiveness of services. This study concludes that strengthening the implementation of PBI-JKN requires data integration, improved technical capacity, clearer communication, and more responsive interagency coordination mechanisms.