Analysis on the implementation of a health improvement project (Garbage Clinical Insurance) in Indonesia: a literature review.

OBJECTIVE: Indonesia Medika has established "Garbage Clinical Insurance" (GCI), which enables the population below the poverty line (BPL) to obtain health insurance by donating their garbage to pay the premium. The objective of this paper was to critically examine the implementation of GCI in Indonesia by reviewing the background, effects, and sustainability of this program.

METHOD: A literature search of studies related to GCI, other types of micro health insurance, and their applications in developing countries was conducted. Recent news (post 2014) related with the implementation of GCI was also consulted.

RESULTS: The literature revealed that the foundation of GCI was informed by the Declaration of Alma Ata with the ideal of making health care services accessible to everyone. Unlike most health insurance, the mechanisms of GCI seem less likely to trigger moral hazard among its beneficiaries. However, as a micro insurance program, the sustainability of GCI continues to be called into question.

CONCLUSIONS: The critical analysis of the present study has highlighted the application of GCI, a micro health insurance initiative, and its relevance to Indonesia. GCI tended to work well as it was able to utilise Indonesia's social capital. However, GCI should aim to increase the benefits package available to its members in order to maintain the sustainability of the program.