Health Justice in the Era of Universal Health Coverage: Legal Accountability of Indonesia’s National Health Insurance (JKN) in Protecting Vulnerable Populations

Abstract

The global expansion of Universal Health Coverage (UHC) has positioned health as a fundamental human right, yet its realization depends heavily on legal accountability and institutional design. Indonesia’s National Health Insurance System (Jaminan Kesehatan Nasional/JKN) represents one of the largest single-payer schemes in the world, covering more than two hundred million citizens. Despite its scale, persistent disparities in access, quality of care, and financial protection remain, particularly among vulnerable populations such as informal workers, rural communities, and persons with disabilities. This article examines JKN through a health justice framework, focusing on the extent to which legal mechanisms ensure equity, accountability, and rights-based protection. Using normative legal analysis combined with policy review, the study evaluates statutory regulations, administrative practices, and judicial decisions related to JKN implementation. The paper situates Indonesia’s experience within global UHC debates, highlighting tensions between cost containment, privatization of service delivery, and state obligations under international human rights law. The findings reveal that while JKN has significantly reduced catastrophic health expenditures, gaps in legal enforcement, weak grievance mechanisms, and unequal regional capacities undermine substantive health justice. This study argues that health justice requires not only coverage expansion but also enforceable legal safeguards that address structural inequality. Strengthening regulatory oversight, improving legal remedies for beneficiaries, and aligning national policies with international health rights norms are essential for advancing equitable health systems in Indonesia and comparable Global South contexts.