Abstract: The implementation of National Health Insurance (JaminanHealth Nasional, JKN) policy was carried out to provide in-patient care coverage for all people in Indonesia. This study examined the driving factors and obstacles in in-patient care in South Sulawesi Province with highest utilization rate and Maluku Province with the lowest rate from the perspective of top-down policy according to the theory of Edwards III. Data collection conducted by doing in-depth interviews with national and local government in Jakarta, South Sulawesi and Maluku provinces in 2016 includes Health Ministry, Health Providers, and Social Security Agency and we analyze the influencing factors with literature review on previous studies and statistical data.