“I was given the card, but no one explained to me how to use it”: Challenges and facilitators of people with disabilities in Indonesia in accessing and using Jaminan Kesehatan Nasional (National Health Insurance)

Jaminan Kesehatan Nasional (JKN), Indonesia’s National Health Insurance, is the world’s largest single-payer scheme. However, an estimated 35% of people with disabilities remain not-enrolled, and many enrolled individuals continue to face high out-of-pocket spending and catastrophic health expenditure. This study aims to explore barriers and facilitators to accessing and using JKN amongst people with disabilities, with a focus on Yogyakarta Province. We conducted a qualitative study using phenomenology approach. We interviewed 22 people with disabilities and 14 key informants (i.e., national and subnational government, organisation of people with disabilities (OPDs), and national disability representatives). Data collection and analysis were guided by the Universal Health Coverage framework. Enrolment was facilitated by formal employment, government subsidies, outreach by social workers and support from OPDs. Key enrolment barriers included lack of identity documents, restrictive poverty criteria for subsidies, and accessibility constraints. Service use was supported by improved referral mechanisms but limited by inadequate coverage of assistive technology (AT) and rehabilitation, uneven distribution and quality of health facilities, perceived negative attitude from health workers, and physical and informational inaccessibility. Financial protection under JKN remained limited, with high out-of-pocket payments driven by gaps in benefit coverage, indirect costs, and underutilisation of services. Improving equity for people with disabilities under JKN requires reforms that account for disability-related costs, expand benefit coverage for AT and rehabilitation, strengthen accessibility standards in health facilities, and pilot disability-inclusive reforms at sub-national level leveraging regional autonomy.