Challenges of Sustainability of Employer-Based Retirement Healthcare Services in Indonesia: A Longitudinal Analysis of Demographic Transition and Healthcare Costs 2019–2023
DOI:
https://doi.org/10.37012/jik.v18i1.3714Keywords:
sustainability, retiree healthcare, demographic transition, healthcare expenditure, health financing.Abstract
Company X continues to provide retiree healthcare benefits to retired employees and their spouses as part of its post-retirement benefits program. However, demographic transition, population ageing, and rising healthcare costs may threaten the sustainability of these employer-sponsored healthcare programs. This study aimed to analyze the sustainability challenges of employer-sponsored retiree healthcare services in terms of demographic transition and changes in healthcare costs. A descriptive comparative longitudinal design was employed using secondary data collected from 2019 to 2023. A total of 61,338 participants were included through total sampling. Data were analyzed using trend analysis and inter-period comparisons. Over the five-year period, the number of active participants declined by 11%, while the mean age increased from 66.11 to 68.51 years. The proportion of new participants decreased from 2.17% to 0.78%, whereas the mortality rate declined to 2.58% in 2023 following the COVID-19 pandemic. Despite the reduction in participants, total healthcare expenditure increased by 24%, while healthcare expenditure per participant rose by 39%, approximately three times higher than the increase in the Indonesian Consumer Price Index over the same period. The sustainability of employer-sponsored retiree healthcare services faces long-term challenges due to population ageing, declining active membership, and healthcare cost growth exceeding national inflation. Long-term sustainability requires appropriate financing strategies, service efficiency, and strengthened promotive and preventive healthcare programs.
References
Bähler, C., Huber, C. A., Brüngger, B., & Reich, O. (2015, 2015/01/22). Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Services Research, 15(1), 23. https://doi.org/10.1186/s12913-015-0698-2
Bali, A. S., & Asher, M. G. (2012). Coordinating Healthcare and Pension Policies: An Exploratory Study (ADBI Working Paper Series, Issue. http://www.adbi.org/workingpaper/2012/08/16/5216.coordinating.healthcare.pension.policies/
Feldhaus, I., & Mathauer, I. (2018, Dec 27). Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature. BMC Health Serv Res, 18(1), 996. https://doi.org/10.1186/s12913-018-3779-1
Galama, T., & Kapteyn, A. (2011, Sep). Grossman's missing health threshold. J Health Econ, 30(5), 1044-1056. https://doi.org/10.1016/j.jhealeco.2011.06.004
Getzen, T. (2013). Health Economics and Financing - 5th Ed. Wiley. https://books.google.co.id/books?id=7MhUEAAAQBAJ
Getzen, T. (2023). Getzen Model of Long-Run Medical Cost Trends Update for 2022 - 2030+ Forecasting in the Time of COVID. Society of Actuaries. https://www.soa.org/resources/research-reports/2022/2023-gretzen-model-update/
Lucifora, C., & Vigani, D. (2018, Dec). Health care utilization at retirement: The role of the opportunity cost of time. Health Economic, 27(12), 2030-2050. https://doi.org/10.1002/hec.3819
McKeown, R. E. (2009, Jul 1). The Epidemiologic Transition: Changing Patterns of Mortality and Population Dynamics. American journal of lifestyle medicine, 3(1 Suppl), 19s-26s. https://doi.org/10.1177/1559827609335350
Mori, T., Hamada, S., Yoshie, S., Jeon, B., Jin, X., Takahashi, H., Iijima, K., Ishizaki, T., & Tamiya, N. (2019, 2019/03/07). The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan. BMC Geriatrics, 19(1), 69. https://doi.org/10.1186/s12877-019-1057-7
Omran, A. R. (1998). The epidemiologic transition theory revisited thirty years later. World Health Statistics Quarterly, 51, 99-109.
Pitacco, E. (2014). Health Insurance: Basic Actuarial Models. Springer International Publishing. https://books.google.co.id/books?id=TJ4vBQAAQBAJ
Rokhim, R., Adawiyah, W., & Faradynawati, I. A. A. (2022). The Indonesian Pension System. In H. Lee, G. Nicolini, & M. Cho (Eds.), International Comparison of Pension Systems: An Investigation from Consumers’ Viewpoint (pp. 357-378). Springer Nature Singapore. https://doi.org/10.1007/978-981-19-6446-6_11
Schieber, G., Baeza, C., Kress, D., & Maier, M. (2006). Financing health systems in the 21st century. In.
Seyedin, H., Afshari, M., Isfahani, P., Hasanzadeh, E., Radinmanesh, M., & Bahador, R. C. (2021). The main factors of supplier-induced demand in health care: A qualitative study. J Educ Health Promot, 10, 49. https://doi.org/10.4103/jehp.jehp_68_20
Soley-Bori, M., Ashworth, M., Bisquera, A., Dodhia, H., Lynch, R., Wang, Y., & Fox-Rushby, J. (2021, Jan). Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature. British Journal of General Practice, 71(702), e39-e46. https://doi.org/10.3399/bjgp20X713897
Sorenson, C., Drummond, M., & Bhuiyan Khan, B. (2013). Medical technology as a key driver of rising health expenditure: disentangling the relationship. ClinicoEconomics and outcomes research, 5, 223-234. https://doi.org/10.2147/ceor.S39634
Suastika, K., Dwipayana, P., Semadi, M. S., & Kuswardhani, R. A. T. (2012). Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases. In C. Sureka (Ed.), Glucose Tolerance (pp. Ch. 5). IntechOpen. https://doi.org/10.5772/52397
WHO. (2022). Ageing and health. WHO. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Williams, G., Cylus, J., Roubal, T., Ong, P., & Barber, S. (2019). Sustainable health financing with an ageing population: implications of different revenue raising mechanisms and policy options. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/331977
World Health Organization. (2018). Final report: working group on the inclusion of NCDs in other programmatic areas: WHO global coordination mechanism on the prevention and control of noncommunicable diseases (Working group 3.1 (2016-2017) CC BY-NC-SA 3.0 IGO). https://iris.who.int/handle/10665/312271
Zulman, D. M., Pal Chee, C., Wagner, T. H., Yoon, J., Cohen, D. M., Holmes, T. H., Ritchie, C., & Asch, S. M. (2015). Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System. BMJ Open, 5(4), e007771. https://doi.org/10.1136/bmjopen-2015-007771
Downloads
Published
How to Cite
Issue
Section
Citation Check
License
Copyright (c) 2026 Cahya Edi Prastyo, Dian Meutia Sari
This work is licensed under a Creative Commons Attribution 4.0 International License.
Jurnal Ilmiah Kesehatan allows readers to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The journal allows the author(s) to hold the copyright without restrictions. Finally, the journal allows the author(s) to retain publishing rights without restrictions Authors are allowed to archive their submitted article in an open access repository Authors are allowed to archive the final published article in an open access repository with an acknowledgment of its initial publication in this journal.
Lisensi Creative Commons Atribusi 4.0 Internasional.
