Optimizing National Health Insurance (JKN) Policy to Support Sustainable Health Development in Gianyar Regency, Bali, Indonesia

The National Health Insurance (JKN) program is a key national strategy for achieving the Sustainable Development Goals (SDGs), particularly Goal 3, which focuses on good health and well-being. This study examines the implementation of JKN in Gianyar Regency, Bali, and its effectiveness in reducing the maternal mortality rate (MMR) and infant mortality rate (IMR), which are critical indicators of sustainable health development. Using a qualitative case study approach grounded in Van Meter and Van Horn's policy implementation model, data were collected through in-depth interviews, participatory observation, and document analysis with triangulation for validation. The results indicate that although Gianyar has achieved a high Universal Health Coverage (UHC) rate of 96.41%, the program's effectiveness is constrained by limited fiscal capacity, uneven distribution of the healthcare workforce, inadequate infrastructure, and low public health literacy. This study contributes to the policy discourse by emphasizing the importance of local contextual adaptation, including community-based strategies and digital integration (e.g., e-Kohort KIA), to optimize the implementation of JKN. The findings underscore the importance of multi-actor policy coordination and context-sensitive health financing innovations in supporting sustainable health outcomes at the subnational level.