Indonesia enforces 10% co-pay rule for private health insurance

This could dampen hospital revenues in fiscal year 2026.

Indonesia's proposed 10% co-payment requirement for private health insurance claims could reduce hospital revenues by 2% to 6% in fiscal year 2026, according to estimates from CGS International. 

The new rule, set to take effect in January 2026, will cap patient contributions at IDR 300,000 for outpatient and IDR3m for inpatient services.

The Financial Services Authority (OJK) plans to enforce the co-payment across all private health insurance policies, making

Indonesia’s policy one of the most stringent in Southeast Asia. 

In comparison, Malaysia and Singapore apply a minimum 5% co-pay, whilst Thailand only mandates co-payments for a small subset of policyholders who exceed certain claim thresholds.

The expected decline in private-insured patient volumes, especially among corporate and middle-income groups, is seen as the main driver of the revenue drop. 

Hospitals with higher exposure to private insurance, such as Mitra Keluarga Karyasehat (MIKA) and Siloam International Hospitals (SILO), could be more affected than those with larger BPJS (Indonesia’s public health insurance) patient bases, such as Medikaloka Hermina (HEAL).

In a best-case scenario, where BPJS absorbs some of the patient downshift, HEAL could even see a small revenue gain. 

However, persistent deficits in BPJS funding and low referral volumes raise concerns about the sustainability of such a spillover.
Since the OJK announcement in early June, hospital share prices have dropped between 4% and 10%. 

Despite these risks, the sector continues to trade at a premium of around 15% to its ASEAN peers, based on a 24x FY26 forecast P/E.

Analysts maintain a neutral outlook on the sector pending further clarity on how insurers will respond with new product designs and whether policy adjustments could mitigate the impact.