The Impact of Universal Health Coverage (UHC) Implementation on Access and Quality of Primary Health Care in Indonesia: A Scoping Review of Policy and System Transformation (2015–2025)

Abstract

The review used a scoping design to map how Indonesia’s JKN system has shaped access to and quality of primary care. It relied on JBI guidance and PRISMA-ScR standards, using the 5A access model and the Institute of Medicine’s quality domains to frame the analysis. A systematic search of Scopus and PubMed (2015–2025) captured studies on JKN policy tools such as capitation, gatekeeping, digital health, and chronic care programs. Articles were screened in two stages, charted in a structured table, and synthesized thematically to reflect regional patterns, policy effects, and equity variations across Indonesia. Ethical approval was not required. The review found 35 eligible studies from 236 initial records, covering diverse designs and regions across Indonesia. Overall, JKN has expanded primary care use and strengthened financing, but equity in service quality still lags, especially in remote provinces. Gatekeeping is taking shape, yet over-referral and weak clinical capacity persist. Programs like capitation, PROLANIS, and digital tools have improved processes, though outcomes in non-communicable and maternal health remain modest. Patient experience is uneven, with issues of privacy, communication, and long waits. Regional gaps are clear, and poorer or subsidized groups continue to face lower-quality care despite higher utilization..