Claims Higher Than Contributions, Health Insurance Claims Surge

Jakarta, CNBC Indonesia - BPJS Kesehatan admits that healthcare service costs are higher than contribution revenues.

The Director of BPJS Kesehatan, Prihati Pujowaskito, stated that this situation is causing BPJS Kesehatan to bear deficits from increasing claims under the National Health Insurance (JKN) programme.

“Healthcare service costs have once again exceeded contribution revenues on an ongoing basis and even with an increasingly upward trend,” she said during a meeting with Commission XI at the DPR RI building in Jakarta on Wednesday (8/4/2026).

Prihati revealed that the current health insurance claims trend is the highest in the last eight years. The JKN programme’s claims ratio reached 111.86% up to February 2026.

“As an implication, if this condition continues, the deficit will keep accumulating and directly pressure the health of the Social Security Fund,” she explained.

BPJS Kesehatan recorded a claims ratio of 110.37% in 2018. However, in 2019, the JKN programme’s claims ratio gradually decreased to 97.05%. Even during the pandemic, the claims ratio fell to 68.29% in 2020 and 63.03% in 2021.

“In 2019, there was an improvement in the condition where the Social Security Fund briefly achieved balance with a more controlled claims ratio,” she noted.

However, the claims ratio rose again in 2022 to 78.78%. It then broke through 104.72% in 2023. The figure continued to swell to 105.78% in 2024 and 107.69% in 2025.

“Since 2023, there has been a quite significant change where the claims ratio is above 100%,” she concluded.