BALINEWSID.COM, TULUNGAGUNG — — Indonesia’s Ministry of Health has begun testing an integrated reform of the National Health Insurance (JKN) system in Tulungagung, East Java, introducing competency-based referrals, standardized inpatient care, and a new diagnosis-based payment system. September 25, 2026.

The pilot is designed to assess the implementation of the three reforms before they are rolled out nationwide. Tulungagung is one of four pilot locations selected by the ministry, alongside Bandung, Makassar and Muara Enim.

Director General of Advanced Health Services at the Ministry of Health, Azhar Jaya, said Tulungagung was selected because of its readiness not only at the hospital level but across the wider healthcare system.

“What we assess is not only the hospitals, but the entire system. Referrals begin at community health centers, clinics and independent medical practices. Therefore, the system in the region must be ready, stable and integrated,” Azhar said.

Under the new referral model, patients will no longer necessarily have to move through hospitals sequentially based on hospital classification.

Instead, referrals will be determined by the medical competencies and services available at each healthcare facility. Patients can be referred directly to a facility capable of providing the treatment required for their medical condition.

“In the past, referrals went sequentially from Class D to C, B and A hospitals. Now, referrals are based on competency. From a community health center, patients can be referred directly to a hospital with the required competency,” Azhar said.

The ministry expects the new system to speed up treatment and reduce unnecessary referral transfers between healthcare facilities.

In Tulungagung, the referral mechanism has also been tested at the primary healthcare level. During a simulation, the referral process was completed in approximately 2 minutes and 47 seconds, below the ministry’s target of less than four minutes.

Standardized Inpatient Care

The second component of the JKN reform is the implementation of the Standard Inpatient Class (KRIS), which aims to establish minimum standards for inpatient facilities and patient comfort.

Under the standards, a hospital room may contain a maximum of four beds. Other requirements include an in-room bathroom, accessibility features, centralized oxygen supply, a nurse-call system, adequate lighting and ventilation, and temperature controls.

Azhar said the higher inpatient standards must be implemented while ensuring that patients continue to have adequate access to hospital beds.

“What we want is better service for the public. Therefore, improving inpatient standards must also ensure that people continue to have access to hospital beds,” he said.

New Payment System

The third reform involves replacing the existing INA-CBGs payment system with Indonesia Diagnosis Related Groups (iDRG).

The iDRG system is designed to make healthcare payments more closely reflect the complexity of diseases and the resources required to treat patients. It also expands the classification of disease severity to reduce discrepancies between the complexity of cases and the tariffs paid to healthcare providers.

Under the existing INA-CBGs system, cases are broadly classified into three levels: mild, moderate and severe.

The iDRG system expands this into five severity levels: mild, mild-to-moderate, moderate, moderate-to-severe and severe.

The new system also accommodates approximately 57,000 disease cases that previously had no corresponding classification and tariff.

“With iDRG, disease classifications are more detailed, allowing payments to better reflect the complexity of the cases being treated,” Azhar said.

BPJS Supports System Integration

BPJS Kesehatan, Indonesia’s national health insurance administrator, is supporting the JKN reform pilot and has emphasized the importance of system integration in ensuring its implementation.

The agency is also encouraging the integration of information systems used by healthcare facilities, the Ministry of Health and BPJS Kesehatan, including P-Care, ASPAK, SISSDMK and Electronic Medical Records (RME).

The Ministry of Health and BPJS Kesehatan, together with local governments and healthcare facilities, will use the pilot program to identify and address implementation issues before the reforms are expanded more widely.

The government says the reform is intended to improve the overall delivery of JKN services through more targeted referrals, standardized inpatient facilities and a payment system that more closely corresponds to the complexity of patients’ medical conditions.