1.

BACKGROUND
The right to health is one of a set of internationally agreed human rights standards and is
inseparable or ‘indivisible’ from other rights (WHO, 2017). At least half of the world’s
population still do not have full coverage of essential health services. All UN Member States
have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the
Sustainable Development Goals (WHO, 2019). Universal health coverage is defined as ensuring
that all people have access to needed health services (including prevention, promotion,
treatment, rehabilitation, and palliation) of sufficient quality to be effective while also ensuring
that the use of these services does not expose the user the financial hardship (WHO, 2019).

Indonesia still experiencing healthcare crisis such as unequally distributed health

services. Therefore, Indonesia needs a universal health coverage system to overcome those
problems. Indonesia as one of the UN members has implemented universal health coverage
system called BPJS Kesehatan (Health Social Security Organizing Agency) which is established
on January 1st, 2014. BPJS Kesehatan is based on social insurance and equity principle using
the “Kartu Jaminan Kesehatan Nasional” (Healthy Indonesia Card). Starting January 21 st , 2019,
BPJS Kesehatan has covered 81.75% of Indonesia's population.

BPJS Kesehatan has a tiered referral system where new patients can obtain specialist or
sub-specialist services after obtaining referrals from health facilities in the earlier strata. There
are 3 levels of health services in Indonesia; the first level which provides basic health services
(Puskesmas as known as community health center); second level that provides specialist health
services (Type B and C hospital); and third level that provide sub-specialist health (Type A
hospital) (Permenkes no. 71 Tahun 2013). This tiered referral system turned out to have
consequences that make patients have to go to the first level health center to reach higher health
facilities so the queues of patients in the first level health center were overcrowded.

2. OUTLINED PROBLEMS

Long queues are one consequence of the BPJS’ tiered referral system where primary
health care is the first gate for BPJS Kesehatan member to obtain health care services. “The
Puskesmas” is a district/city official technical implementation unit responsible for organizing
health development in a work area (Peraturan Menteri Kesehatan Republik Indonesia Nomor 74
Tahun 2016). In reality in the field, Puskesmas services are often unsatisfactory because of the
long queues and long waiting times. This long queues will lead to prolong patient’s waiting time.
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