Comparative study of UHC implementation in Indonesia and Malaysia: Literature review
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Oct 10, 2025
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Abstract
Universal Health Coverage Universal Health Coverage (UHC) is a key principle of an equitable health system, ensuring access to healthcare services without financial burden. Indonesia, with its National Health Insurance (JKN), and Malaysia, with its tax-based public healthcare system, have different approaches to implementation. This study compares the implementation of UHC in Indonesia and Malaysia, including the financing system, resource distribution, service coverage, and service quality. The study used a literature review with the PRISMA approach. From the total number of articles found in various databases, titles, abstracts, and inclusion-exclusion criteria were screened, leaving 15 relevant articles for analysis. Indonesia, through JKN, has covered a large portion of the population, but faces disparities in access, unequal distribution of healthcare workers, and high out-of-pocket costs for specialist services. Malaysia has near-universal coverage with subsidized public services and financial protection for poor households, although there is inequality between the public and private sectors. Indonesia needs to improve infrastructure, equitable distribution of healthcare workers, public education regarding active participation, and strengthened program management. Malaysia is advised to strengthen the integration of the public and private sectors and maintain progressive financing to reduce financial risks for poor households.
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How to Cite
Rahim, M. A. B., Rosyidah, R. and Hidayat, M. S. (2025) “Comparative study of UHC implementation in Indonesia and Malaysia: Literature review”, Science Midwifery, 13(4), pp. 1115-1124. doi: 10.35335/midwifery.v13i4.2106.
References
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Dongen, D.-M. van. (2022). Impact of Health Financing on Healthcare Quality and Affordability in Malaysia: A Conceptual Review. Malaysian Journal of Medical and Biological Research, 9(1), 33–40. https://doi.org/10.18034/mjmbr.v9i1.638
Ekawati, F. M., & Claramita, M. (2021). Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN). Journal of Primary Care and Community Health, 12. https://doi.org/10.1177/21501327211023707
Erlangga, D., Ali, S., & Bloor, K. (2019). The impact of public health insurance on healthcare utilisation in Indonesia: evidence from panel data. International Journal of Public Health, 64(4), 603–613. https://doi.org/10.1007/s00038-019-01215-2
Hassan, N. Z. A. M., Kunusagaran, M. S. J. M. N. S., Zaimi, N. A., Aminuddin, F., Ab Rahim, F. I., Jawahir, S., & Abdul Karim, Z. (2022). The inequalities and determinants of Households’ Distress Financing on Out-off-Pocket Health expenditure in Malaysia. BMC Public Health, 22(1), 1–14. https://doi.org/10.1186/s12889-022-12834-5
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Jauhar, A., & Nadjib, M. (2024). The Role of Social Health Insurance in Achieving Universal Health Coverage in Asia : A Systematic Review. Jurnal Ekonomi Kesehatan Indonesia, 9(2), 172–186. https://doi.org/10.7454/eki.v9i2.1139
Kaiser, A. H., Rotigliano, N., Flessa, S., Ekman, B., & Sundewall, J. (2023). Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia. In PLoS ONE (Vol. 18, Issue 7 JULY). https://doi.org/10.1371/journal.pone.0288269
Kanna, M. K. K., Chin, K. W., Yik, K. C., & Rai, S. B. (2020). Health service utilization by a semi-urban community in Kedah, Malaysia, 2019. International Journal Of Community Medicine And Public Health, 7(8), 2956. https://doi.org/10.18203/2394-6040.ijcmph20203369
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Kosasih, D. M., Adam, S., Uchida, M., Yamazaki, C., Koyama, H., & Hamazaki, K. (2022). Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13142-8
Lim, W. M., Kumar, S., & Ali, F. (2022). Advancing knowledge through literature reviews: ‘what’, ‘why’, and ‘how to contribute.’ The Service Industries Journal, 42(7–8), 481–513. https://doi.org/10.1080/02642069.2022.2047941
Liu, Y., Gong, L., Niu, H., Jiang, F., Du, S., & Jiang, Y. (2024). Health system efficiency and equity in ASEAN: an empirical investigation. Cost Effectiveness and Resource Allocation, 22(1). https://doi.org/10.1186/s12962-024-00588-3
Manita, R., & Afrita, I. (2024). Aksebilitas Pembiayaan Dalam Program Jaminan Kesehatan Nasional. INNOVATIVE: Journal Of Social Science Research, 4, 12874–12886. https://j-innovative.org/index.php/Innovative
Menteri Keuangan RI. (2018). Peraturan Menteri Keuangan Republik Indonesia Nomo 194/PMK.02/2018 Tentang Tata Cara Pengelolaan Penerimaan Negara Bukan Pajak Dari FKTP FKRTL. Peraturan Menteri Keuangan Republik Indonesia. https://peraturan.bpk.go.id/Details/113698/pmk-no-194pmk022018
Noor, N. M., & Mudaris, I. S. M. (2021). Health and Social Protection: Continuing Universal Health Coverage. Special Issue To Report: Building Resilience: Towards Inclusive Social Protection In Malaysia, December. www.KRInstitute.org.
Nugraheni, D. A., Satibi, S., Kristina, S. A., & Puspandari, D. A. (2022). Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey. International Journal of Environmental Research and Public Health, 19(22). https://doi.org/10.3390/ijerph192215017
Ong, S. M., Lim, M. T., Tong, S. F., Kamaliah, M. N., Groenewegen, P., & Sivasampu, S. (2022). Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC. PLoS ONE, 17(10 October), 1–14. https://doi.org/10.1371/journal.pone.0276480
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), 1–11. https://doi.org/10.1186/s13643-021-01626-4
Perdana, N. R., Adhasari, G., & Mahadewi, E. P. (2022). Challenges and Implementation of Universal Health Coverage Program in Indonesia. International Journal of Health and Pharmaceutical (IJHP), 2(3), 589–596. https://doi.org/10.51601/ijhp.v2i3.97
Plianbangchang, S. (2018). Universal health coverage (UHC). Journal of Health Research, 32(4), 322–324. https://doi.org/10.1108/JHR-05-2018-029
Pradana, A. A., Casman, C., Rohayati, R., & Kamal, M. (2022). Program Universal Health Coverage (Uhc) Di Indonesia. Jurnal Endurance, 7(2), 462–473. https://doi.org/10.22216/jen.v7i2.1363
Pratiwi, A. B., Setiyaningsih, H., Kok, M. O., Hoekstra, T., Mukti, A. G., & Pisani, E. (2021). Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability. BMJ Open, 11(10). https://doi.org/10.1136/bmjopen-2021-050565
Ramadhan, A. P., Budiyono, B., & Santoso, D. (2020). Indonesia Universal Health Coverage Implementation on University Students. Journal of Government and Civil Society, 4(2), 219. https://doi.org/10.31000/jgcs.v4i2.2612
Risyanda, L. D. (2025). The challenges and opportunities in implementing universal health coverage: a comparative study of Indonesia, Malaysia, and Thailand. International Journal of Research in Business and Social Science (2147- 4478), 14(3), 389–397. https://doi.org/10.20525/ijrbs.v14i3.3980
Sammon, D., McCarthy, S., Thummadi, V., & Wibisono, A. (2024). Special issue editorial: doing the literature review. Journal of Decision Systems, 33(4), 531–536. https://doi.org/10.1080/12460125.2024.2410045
Saputro, C. R. A., & Fathiyah, F. (2022). Universal Health Coverage: Internalisasi Norma di Indonesia. Jurnal Jaminan Kesehatan Nasional (JJKN), 2(2), 204–216. https://doi.org/10.53756/jjkn.v2i2.108
Soraya, S., Syamanta, T., Harahap, H. S. R. B., Coovadia, C., & Greg, M. (2023). Impact of the National Health Insurance Program (JKN) on Access to Public Health Services: A Comprehensive Analysis. Jurnal Ilmu Pendidikan Dan Humaniora, 12(3), 133–151. https://doi.org/10.35335/jiph.v12i3.7
Suyanti, E., Afrita, I., & Oktapani, S. (2024). Pelaksanaan Program Universal Health Coverage (UHC) Di Indonesia. INNOVATIVE: Journal Of Social Science Research, 4, 7123–7130.
Thomas, S., Beh, L., & Nordin, R. Bin. (2011). Health care delivery in Malaysia: Changes, challenges and champions. Journal of Public Health in Africa, 2(2), 93–97. https://doi.org/10.4081/jphia.2011.e23
Wahdi, A. E., Sutanto, E., Setyawan, A., Astrini, Y. P., Adani, N., Mardani, H., Maulana, N., Pattnaik, A., Trihono, T., & Wilopo, S. A. (2023). National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis. Gates Open Research, 7, 105. https://doi.org/10.12688/gatesopenres.14642.2
Wiasa, I. N. D. (2022). Jaminan Kesehatan Nasional Yang Berkeadilan Menuju Kesejahteraan Sosial. CV. Feniks Muda Sejahtera.
World Health Organization. (2020). What is universal health coverage? World Health Organization. https://www.who.int/news-room/questions-and-answers/item/what-is-universal-health-coverage
World Health Organization. (2023). Frequently Asked Questions Universal Health Coverage Global Monitoring Report 2023. 1, 1–4. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/total-population-pushed-below-the-2.15-a-
World Health Organization. (2025). Universal health coverage (UHC). WHO. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
Zhafarin, B. S., Ghifary, H., Novianti, P. A., & Istanti, N. D. (2023). Analisis Efektivitas Pelaksanaan UHC Dalam Meningkatkan Kualitas Layanan Kesehatan Di Indonesia. Jurnal Ventilator, 1(1), 1–9.
Baharin, M. F. A., Juni, M. H., & Abdul Manaf, R. (2022). Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia. International Journal of Environmental Research and Public Health, 19(8). https://doi.org/10.3390/ijerph19084500
Balqis-Ali, N. Z., Anis-Syakira, J., Fun, W. H., & Sararaks, S. (2021). Private Health Insurance in Malaysia: Who Is Left Behind? Asia-Pacific Journal of Public Health, 33(8), 861–869. https://doi.org/10.1177/10105395211000913
Dongen, D.-M. van. (2022). Impact of Health Financing on Healthcare Quality and Affordability in Malaysia: A Conceptual Review. Malaysian Journal of Medical and Biological Research, 9(1), 33–40. https://doi.org/10.18034/mjmbr.v9i1.638
Ekawati, F. M., & Claramita, M. (2021). Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN). Journal of Primary Care and Community Health, 12. https://doi.org/10.1177/21501327211023707
Erlangga, D., Ali, S., & Bloor, K. (2019). The impact of public health insurance on healthcare utilisation in Indonesia: evidence from panel data. International Journal of Public Health, 64(4), 603–613. https://doi.org/10.1007/s00038-019-01215-2
Hassan, N. Z. A. M., Kunusagaran, M. S. J. M. N. S., Zaimi, N. A., Aminuddin, F., Ab Rahim, F. I., Jawahir, S., & Abdul Karim, Z. (2022). The inequalities and determinants of Households’ Distress Financing on Out-off-Pocket Health expenditure in Malaysia. BMC Public Health, 22(1), 1–14. https://doi.org/10.1186/s12889-022-12834-5
Herawati, Franzone, R., & Chrisnahutama, A. (2020). Universal Health Coverage: Tracking Indonesia’s Progress. Perkumpulan PRAKARSA.
Jauhar, A., & Nadjib, M. (2024). The Role of Social Health Insurance in Achieving Universal Health Coverage in Asia : A Systematic Review. Jurnal Ekonomi Kesehatan Indonesia, 9(2), 172–186. https://doi.org/10.7454/eki.v9i2.1139
Kaiser, A. H., Rotigliano, N., Flessa, S., Ekman, B., & Sundewall, J. (2023). Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia. In PLoS ONE (Vol. 18, Issue 7 JULY). https://doi.org/10.1371/journal.pone.0288269
Kanna, M. K. K., Chin, K. W., Yik, K. C., & Rai, S. B. (2020). Health service utilization by a semi-urban community in Kedah, Malaysia, 2019. International Journal Of Community Medicine And Public Health, 7(8), 2956. https://doi.org/10.18203/2394-6040.ijcmph20203369
Kementerian Kesehatan. (2022). Panduan Layanan Peserta Jaminan Kesehatan Nasional Kartu Indonesia Sehat (JKN-KIS). Jaminan Kesehatan Nasional, 3, 1–111. https://www.bpjs-kesehatan.go.id/bpjs/dmdocuments/4bd28c6ea8f022040f6eb93cfcd6e723.pdf
Kementerian Kesehatan Republik Indonesia. (2023). Transformasi Kesehatan Mewujudkan Masyarakat Indonesia Sehat dan Unggul. Kemenkes RI.
Khor, S. K., Chua, E. P. W., & Fried, C. (2021). Sustainability and Resilience in the Greek Health System (Issue November). Center for Asia-Pacific Resilience and Innovation. https://www3.weforum.org/docs/WEF_PHSSR_Greece_2023.pdf
Kosasih, D. M., Adam, S., Uchida, M., Yamazaki, C., Koyama, H., & Hamazaki, K. (2022). Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13142-8
Lim, W. M., Kumar, S., & Ali, F. (2022). Advancing knowledge through literature reviews: ‘what’, ‘why’, and ‘how to contribute.’ The Service Industries Journal, 42(7–8), 481–513. https://doi.org/10.1080/02642069.2022.2047941
Liu, Y., Gong, L., Niu, H., Jiang, F., Du, S., & Jiang, Y. (2024). Health system efficiency and equity in ASEAN: an empirical investigation. Cost Effectiveness and Resource Allocation, 22(1). https://doi.org/10.1186/s12962-024-00588-3
Manita, R., & Afrita, I. (2024). Aksebilitas Pembiayaan Dalam Program Jaminan Kesehatan Nasional. INNOVATIVE: Journal Of Social Science Research, 4, 12874–12886. https://j-innovative.org/index.php/Innovative
Menteri Keuangan RI. (2018). Peraturan Menteri Keuangan Republik Indonesia Nomo 194/PMK.02/2018 Tentang Tata Cara Pengelolaan Penerimaan Negara Bukan Pajak Dari FKTP FKRTL. Peraturan Menteri Keuangan Republik Indonesia. https://peraturan.bpk.go.id/Details/113698/pmk-no-194pmk022018
Noor, N. M., & Mudaris, I. S. M. (2021). Health and Social Protection: Continuing Universal Health Coverage. Special Issue To Report: Building Resilience: Towards Inclusive Social Protection In Malaysia, December. www.KRInstitute.org.
Nugraheni, D. A., Satibi, S., Kristina, S. A., & Puspandari, D. A. (2022). Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey. International Journal of Environmental Research and Public Health, 19(22). https://doi.org/10.3390/ijerph192215017
Ong, S. M., Lim, M. T., Tong, S. F., Kamaliah, M. N., Groenewegen, P., & Sivasampu, S. (2022). Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC. PLoS ONE, 17(10 October), 1–14. https://doi.org/10.1371/journal.pone.0276480
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), 1–11. https://doi.org/10.1186/s13643-021-01626-4
Perdana, N. R., Adhasari, G., & Mahadewi, E. P. (2022). Challenges and Implementation of Universal Health Coverage Program in Indonesia. International Journal of Health and Pharmaceutical (IJHP), 2(3), 589–596. https://doi.org/10.51601/ijhp.v2i3.97
Plianbangchang, S. (2018). Universal health coverage (UHC). Journal of Health Research, 32(4), 322–324. https://doi.org/10.1108/JHR-05-2018-029
Pradana, A. A., Casman, C., Rohayati, R., & Kamal, M. (2022). Program Universal Health Coverage (Uhc) Di Indonesia. Jurnal Endurance, 7(2), 462–473. https://doi.org/10.22216/jen.v7i2.1363
Pratiwi, A. B., Setiyaningsih, H., Kok, M. O., Hoekstra, T., Mukti, A. G., & Pisani, E. (2021). Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability. BMJ Open, 11(10). https://doi.org/10.1136/bmjopen-2021-050565
Ramadhan, A. P., Budiyono, B., & Santoso, D. (2020). Indonesia Universal Health Coverage Implementation on University Students. Journal of Government and Civil Society, 4(2), 219. https://doi.org/10.31000/jgcs.v4i2.2612
Risyanda, L. D. (2025). The challenges and opportunities in implementing universal health coverage: a comparative study of Indonesia, Malaysia, and Thailand. International Journal of Research in Business and Social Science (2147- 4478), 14(3), 389–397. https://doi.org/10.20525/ijrbs.v14i3.3980
Sammon, D., McCarthy, S., Thummadi, V., & Wibisono, A. (2024). Special issue editorial: doing the literature review. Journal of Decision Systems, 33(4), 531–536. https://doi.org/10.1080/12460125.2024.2410045
Saputro, C. R. A., & Fathiyah, F. (2022). Universal Health Coverage: Internalisasi Norma di Indonesia. Jurnal Jaminan Kesehatan Nasional (JJKN), 2(2), 204–216. https://doi.org/10.53756/jjkn.v2i2.108
Soraya, S., Syamanta, T., Harahap, H. S. R. B., Coovadia, C., & Greg, M. (2023). Impact of the National Health Insurance Program (JKN) on Access to Public Health Services: A Comprehensive Analysis. Jurnal Ilmu Pendidikan Dan Humaniora, 12(3), 133–151. https://doi.org/10.35335/jiph.v12i3.7
Suyanti, E., Afrita, I., & Oktapani, S. (2024). Pelaksanaan Program Universal Health Coverage (UHC) Di Indonesia. INNOVATIVE: Journal Of Social Science Research, 4, 7123–7130.
Thomas, S., Beh, L., & Nordin, R. Bin. (2011). Health care delivery in Malaysia: Changes, challenges and champions. Journal of Public Health in Africa, 2(2), 93–97. https://doi.org/10.4081/jphia.2011.e23
Wahdi, A. E., Sutanto, E., Setyawan, A., Astrini, Y. P., Adani, N., Mardani, H., Maulana, N., Pattnaik, A., Trihono, T., & Wilopo, S. A. (2023). National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis. Gates Open Research, 7, 105. https://doi.org/10.12688/gatesopenres.14642.2
Wiasa, I. N. D. (2022). Jaminan Kesehatan Nasional Yang Berkeadilan Menuju Kesejahteraan Sosial. CV. Feniks Muda Sejahtera.
World Health Organization. (2020). What is universal health coverage? World Health Organization. https://www.who.int/news-room/questions-and-answers/item/what-is-universal-health-coverage
World Health Organization. (2023). Frequently Asked Questions Universal Health Coverage Global Monitoring Report 2023. 1, 1–4. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/total-population-pushed-below-the-2.15-a-
World Health Organization. (2025). Universal health coverage (UHC). WHO. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
Zhafarin, B. S., Ghifary, H., Novianti, P. A., & Istanti, N. D. (2023). Analisis Efektivitas Pelaksanaan UHC Dalam Meningkatkan Kualitas Layanan Kesehatan Di Indonesia. Jurnal Ventilator, 1(1), 1–9.