Jakarta, October 15, 2025 - Amidst rising medical inflation, potential social security fund deficits, and recurring claims disputes, Indonesia's healthcare system walks a delicate balance between medical idealism and cost calculations. Who maintains that balance? The answer may lie in a discipline that has long escaped the public eye: insurance medicine.
The health cost crisis, service inequality, and claim leakage indicate the need for medical science-based financing governance, not just actuarial formulas. Insurance medicine is not present to choose between the medical or financial side, but to bridge the two so that the social security system and the insurance industry are healthy, equitable and sustainable again.
Doctors must be the guardians of reason in the health system
The Chairman of the PERDOKJASI Central Board, Air Marshal (Ret.) Dr. dr. Wawan Mulyawan, SpBS, Subsp.N-TB, SpKP, AAK, emphasized that insurance medicine is "the logical evolution of the medical profession in the midst of the complexity of social security and health insurance."
"So far, the health financing system has been led by cost logic, not clinical logic. Whereas service quality and financial sustainability cannot be separated. Evidence-based insurance medicine restores the role of doctors as gatekeepers as well as policy advisors," he said.
According to him, without the involvement of doctors in benefit design, claims control, and risk evaluation, the social security system will only be a tug-of-war between payers and providers.
"We need an Insurance Medicine Council that maintains a balance between participant rights, fund sustainability, and professional responsibility," said Dr. Wawan.
Health is not just a cost, but a financial asset for the nation
From the industry side, Dr. Emira E. Oepangat, FLMI, CFP, AEP, AAAIJ, AAAK, as Chairperson of the FORESIGHT PERDOKJASI 2025 Committee, sees insurance medicine as a bridge between medical and financial.
"We talk about financial sustainability, but how can it be sustainable if the risk analysis is not supported by clinical data? Doctors and actuaries must sit at the same table," said Dr. Emira, who is also Country Director of Indonesia LOMA LIMRA International.
He highlighted medical inflation of 13-15 percent per year, with chronic diseases such as kidney and heart failure accounting for half of BPJS claims.
"If this trend is left unchecked, companies will cut benefits, JKN participants will endure long queues. Insurance medicine builds health-financing intelligence to prevent claim leakage and protect participants," he explained.
According to him, the perspective that considers health as a cost burden creates a policy blind spot. In fact, health is the nation's financial asset that determines productivity and economic stability.
Driving Indonesia's Insurance Medicine Ecosystem
Dr. Wawan cited countries such as Switzerland, the Netherlands, and Sweden, where insurance medicine has been integrated into the social security system through evidence-based decision making.
"It is time for Indonesia to follow suit. Doctors should not only be implementers of claims, but also designers of an equitable system," he said.
Meanwhile, Dr. Emira believes that the key to the future lies in digital integration and data transparency.
"We have a golden opportunity to build a Health Insurance Intelligence Hub - a shared data platform between doctors, actuaries and regulators. That is the future of Indonesian insurance medicine," he emphasized.
The world has moved on, Indonesia cannot be left behind
In Switzerland, the University of Basel has a Master of Advanced Studies in Insurance Medicine program to train doctors to become system assessors - scientific evidence-based policy assessors. The Netherlands and Sweden even put insurance doctors on national disability policy boards.
"Indonesia must have the courage to build a similar ecosystem," said Dr. Wawan. "Without doctors who understand financing and risk, the social security system will continue to be busy putting out fires without knowing where the smoke comes from."
Connecting Knowledge, Not Separating Professions
Both Dr. Wawan and Dr. Emira emphasized that insurance medicine is not in favor of the industry or BPJS, but rather the balance of the system.
"We need health governance based on evidence, data, and professional integrity - not sectoral interests," said Dr. Emira.
PERDOKJASI is currently forming a Medical Advisory Board across the medical profession to provide scientific recommendations in claims policy, tariffs, and benefit design. This board is expected to be the link between the medical world and financial governance.
