Cost Structure and Budget Implications of Free Health Check-Up Services Delivered by Private Clinics in Bandung City, Indonesia

Abstract

The Free Health Check-Up program (Cek Kesehatan Gratis—CKG) is a national preventive health initiative in Indonesia. While implementation has primarily relied on primary health centers (Puskesmas), engaging private clinics is increasingly considered to improve service coverage. However, evidence on the cost structure, budgetary implications, and service delivery capacity of private clinics remains limited. This study aims to estimate the unit costs of CKG services, examine the underlying cost structure, and assess the budgetary implications of expanding CKG service delivery through private clinics in Bandung City, Indonesia. A bottom-up costing approach using Activity-Based Costing (ABC) was applied based on primary data collected from selected private clinics participating in the National Health Insurance (JKN) scheme. Cost components included human resources, medical consumables, medical equipment, and laboratory services, classified into direct medical, direct non-medical, and indirect (overhead) costs. Unit cost estimates were generated for CKG services and used as inputs for budget implications conducted from the service provider perspective. The budget implications projected annual budget requirements under two scenarios: (1) Full Coverage of CKG Services and (2) Full Coverage of CKG Services. The results indicate that the cumulative projected cost of CKG implementation until 2030 reaches USD 24.82 million, driven by expanded service coverage and increased population uptake. Compared with Bandung’s economic capacity, this cost remains relatively small, with full implementation accounting for only about 0.1% of per capita income. Furthermore, the limited capacity of Puskesmas highlights the need for additional implementation support. Private clinics have the potential to expand service coverage in urban areas; however, variations in cost structures have important implications for financing and implementation strategies. These findings provide empirical evidence to inform sustainable financing policies and the strategic engagement of private providers in preventive health services.