UNILATERAL CONTRACT IN THE COOPERATION BETWEEN BPJS HEALTH AND HOSPITALS: AN ANALYSIS OF PARTY IMBALANCE

Abstract

The cooperation between BPJS Kesehatan (Indonesia’s National Health Insurance Agency)
and hospitals represents a form of public–private partnership (PPP) with distinctive
characteristics within the national health system. In practice, the contractual relationship
between these two entities is often perceived as placing BPJS Kesehatan in a more dominant
position. This occurs because BPJS simultaneously functions as regulator, purchaser of health
services, and supervisor of contract implementation. This study aims to examine the legal
characteristics of the cooperation contract, assess the extent to which unilateral elements
emerge within its regulatory framework, and analyze the implications of such imbalance for
hospital autonomy, legal certainty, and the economic sustainability of healthcare institutions.
Using a normative juridical method, this research reviews primary legal sources such as Law
No. 24 of 2011 on BPJS, BPJS Regulation No. 1 of 2014 concerning Cooperation with
Healthcare Facilities, and Article 1338 of the Indonesian Civil Code. These sources are
supported by secondary literature on administrative law theory and public contract concepts.
The analysis shows that the cooperation contract between BPJS Kesehatan and hospitals tends
to be substantively unbalanced, mainly due to the discretionary authority of BPJS to interpret,
modify, and even terminate the contract unilaterally. This condition weakens the bargaining
position of hospitals and may create structural inequality in the implementation of the national
health insurance system.
These findings pose challenges to the principles of contractual justice and good governance,
particularly with regard to fairness, transparency, and accountability. This research
recommends restructuring the cooperation into a more equitable bilateral administrative
contract and offers conceptual contributions to the development of public contract law and
reform of the BPJS system in Indonesia.