Indonesian Global Hospital Budget
Executive Summary
This project supports the Ministry of Health’s strategic reform of hospital payment mechanisms under the National Health Insurance (JKN) program through the development of a comprehensive Global Budget framework. The objective was to design a fiscally sustainable provider payment model capable of controlling expenditure growth while maintaining fairness, adequacy, and appropriate service incentives. In response to rising case complexity, increasing utilization, and the risk of JKN financial deficits, the project sought to translate high-level policy direction into a technically robust, data-driven, and operationally feasible budgeting mechanism.
Reconstra played a central role in this initiative by conducting in-depth historical utilization and case-mix analysis using BPJS sample datasets from 2022–2023. The team produced a comprehensive analytical report covering district-level active membership patterns, outpatient and inpatient utilization rates, Case Mix Index (CMI) dynamics, and expenditure trends. These empirical findings formed the foundation for the design of Global Budget formula options, including soft cap mechanisms, DRG-based allocation logic (Cost Weight × Base Rate × Adjustment Factor), price tapering structures, CMI and volume caps, as well as tailored considerations for DTPK hospitals and priority KJSU services. Reconstra also developed simulation models to stress-test fiscal scenarios, assess deficit risks, and refine policy parameters through technical workshops and taskforce discussions, including the 9th Global Budget Workshop.
Implemented throughout 2025 in alignment with the Ministerial Decree drafting timeline (targeted completion by December 2025), the project delivered analytical evidence, formula simulations, and implementation-ready policy recommendations. The outputs directly equip the client with a structured, evidence-based Global Budget design framework to strengthen cost containment, improve regional payment equity, and safeguard the long-term financial sustainability of JKN.
