HealthAccessInIndonesia 2013Dec11 HarvardClub101213

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MOVING TOWARDS

UNIVERSAL HEALTH ACCESS IN

INDONESIA

Dr. Nafsiah Mboi, Sp.A, MPH Minister of Health

MINISTER OF HEALTH REPUBLIC OF

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OUTLINE

1. INTRODUCTION

2. EXISTING HEALTH INSURANCE IN INDONESIA

3. POLICY & DESIGN OF INDONESIA’S

NATIONAL HEALTH INSURANCE SCHEME

3. POLICY & DESIGN OF INDONESIA’S

NATIONAL HEALTH INSURANCE SCHEME

4. CONCLUSION

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About

Indonesia

 World’s largest archipelago

– 17,000 islands

 World’s 4

most populated

nation - 230 million

people, unevenly

distributed



_{World’s largest Moslem}

population



_{Strong cultural and}

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INDONESIAN HEALTH FINANCING 2011

 _GDP_{per capita US$ 3,494}

 _Total_{Health Expenditure}__{Rp 214,9 Trillion,}

 2.9% of GDP

 _{Per capita}_{Health Expenditure}__{US$ 101.10}

 _{37.5% from}_public_spending,

61.4% from private spending

 _72%_{of population}__{now covered}_by

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NATIONAL SOCIAL SECURITY SYSTEM

Law

No. 40/2004

The essence:

To synchronize

implementation of social security in Indonesia

The

purpose:

To guarantee protection and

social welfare for all people

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4 2 3 1

COMPONENTS OF

SOCIAL SECURITY SYSTEM

Health Insurance Accident insurance

Life insurance Public pension

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SOCIAL SECURITY CONCEPT

4 2 3 1

Add Your Text

All employed citizens (in formal or informal sectors) who have income shall contribute to the program

Basic benefits guaranteed

Those who wish more protection, are free to purchase additional services on commercial basis

Planned, phased implementation

5 _{Government is regulator}

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2. EXISTING HEALTH

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Some Short Comings in

EXISTING HEALTH INSURANCE SCHEMES

1.Lack of integration in

implementation and coverage.

2.Fragmented fund-pooling & management

3.Different benefit packages and limits among schemes

4.Variations in management

systems of different providers

5.Limited and uneven monitoring, evaluation and coordination

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EXISTING

HEALTH INSURANCE COVERAGE

Coverage : June 2013

176.844.161 people covered (72 % of population)

• _{JAMKESMAS: 86.400.000 (36,3 %)} • _{JAMKESDA : 45.595.520 (16,79 %)}

• _{ASKES PNS : 16.548.283 (06,69 %)}

• _{TNI/POLRI/PNS KEMHAN : 1.412.647 (00,59 %}₎

• _{JPK JAMSOSTEK : 7.026.440 (02,96 %)}

• _{COMPANY SELF INSURANCE} _:_16.923.644

(07,12 %)

• _{COMMERCIAL INSURANCE : 2.937.627 (01,2}

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EXISTING HEALTH INSURANCE COVERAGE

(JUNE 2013)

36.3 28

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3. POLICY & DESIGN OF NATIONAL HEALTH INSURANCE

(STARTING FROM 1 JANUARY 2014)

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LEGAL FOUNDATION FOR

INDONESIA’S NATIONAL HEALTH

INSURANCE

LEGAL FOUNDATION FOR

INDONESIA’S NATIONAL HEALTH

INSURANCE

• _{Constitution of}₁₉₄₅

• _{Act No 40/ 2004 on}_{National Social}

Security System (UU SJSN)

• _{Act No 24/2011 on} _{Social Security}

Agency (BPJS)

• _{Governmental Decree No 101/2012}

on Beneficiaries of Governmental subsidy (PBI)

• _{Pres Decree No 12/2013} _{on Social}

Health Insurance

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ROADMAP TO UHC

20% 50% 75% 100%

20% 50% 75% 100%

10% 30% 50% 70% 100% 100%

`Enterprises 2014 2015 2016 2017 2018 2019

Big 20% 50% 75% 100% Middle 20% 50% 75% 100% Small 10% 30% 50% 70% 100% Micro 10% 25% 40% 60% 80% 100%

201 2

201

2 20120133 20120144 20120155 20120166 20120177 20120188 20120199

Transformation from 4 existing schemes to BPJS Kesehatan (JPK Jamsostek, Jamkesmas, Askes PNS,

TNI Polri )

Transformation from 4 existing schemes to BPJS Kesehatan (JPK Jamsostek, Jamkesmas, Askes PNS,

TNI Polri )

Membership expansion to big, middle, small and micro enterprises

Membership expansion to big, middle, small and micro enterprises Procedure setting on membersh ip and contributi on Procedure setting on membersh ip and contributi on Company mapping and socializa tion Company mapping and socializa tion

Consumer satisfaction measurement every 6 Consumer satisfaction measurement every 6

Integration of Jamkesda into BPJS Kesehatan and regulation of commercial insurance industry

Pengalihan Kepesertaan TNI/POLRI ke BPJS Kesehatan Pengalihan Kepesertaan TNI/POLRI ke BPJS Kesehatan Synchronization Synchronization

Coverage of various existing schemes

148,2mio

Coverage of various existing schemes

148,2mio

121,6 mio covered by BPJS

Keesehatan

121,6 mio covered by BPJS

Keesehatan 50,07 mio covered by other schemes 50,07 mio covered by other schemes

257,5 mio (all Indonesian people) covered by BPJS Kesehatan

257,5 mio (all Indonesian

people) covered by

BPJS Kesehatan_{Level of}

satisfaction 85% Level of satisfaction 85% Activities: Transformation, Integration, Expansion Activities: Transformation, Integration, Expansion B S K 73,8 mio uninsured people 73,8 mio uninsured people Uninsured people 90,4 mio

Uninsured people 90,4 mio

Presidential decree on operational support for Army/Police Presidential decree on operational support for Army/Police 86,4 mio PBI 86,4 mio PBI

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MEMBERSHIP

• _Members

All people who have paid premium

or for whom it has been paid

•_{Two categories of members:}

a.People with incomes below the

stipulated poverty line  premium paid by government

b.All others pay the premium - workers in formal sector, independent members,

including foreigners who work in

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Premium of National Health

Insurance

MEMBER PREMIUM Monthly

membership fee (IDR) REMARK SUBSIDIZED MEMBER NOMINAL (per member)

19.225,- Class 3 IP care CIVIL

SERVANT/ARMY/ POLICE/ RETIRED

(per household ) 2% from employee 3% from employer Class 1 & 2 IP care OTHER WORKERS WHO RECEIVE MONTHLY SALARY/WAGE 4,5 % (per household) And 5% (per household)

Until 30 June 2015:

0,5% from employee 4% from employer

Start from 1 July2015:

1% from employee 4% from employer

Class 1 & 2 IP care

NON WAGE EARNERS/

INDEPENDENT

NOMINAL

(per member) 1. 25,500,- 2. 42,500,-3. 59,500,-

1. Class 3 IP care

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BENEFIT PACKAGES

• _{Benefit package :}

_personal

health care covering promotive,

preventive, curative &

rehabilitative services

• _{Benefit package :}

_{includes both}

medical & non medical, such as

hosp accommodation, ambulance

etc

• _Regulation

_{stipulates services}

covered

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FINANCE:

CONTRIBUTION

(PREMIUM)

FINANCE:

CONTRIBUTION

(PREMIUM)

 _{Contribution for}_{people below the}

poverty line (PBI)→ paid by central (and local) government

 _{Contributions of}_{members paying their}

own premium

a. Workers in formal employment : premium is shared by employees and employer calculated as a % of

salary/wage.

b. Self and non employed: pay nominal/ flat rate (determined by Pres Decree)

 _{Contributions/ premiums are pooled}

and create the major source of funding for

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HEALTH CARE PROVIDERS AND

PAYMENT METHODS

HEALTH CARE PROVIDERS AND

PAYMENT METHODS

Healthcare providers

 Primary health care providers_{: Public}

Health Service, Private clinics, Primary Care Doctors

 Secondary & tertiary health care

providers: Hospitals both public hospitals and private hospitals

Payment methods

 Primary health care providers_:

capitation & non capitation

 _{Secondary and tertiary health care}

providers: Ina-CBG’s (Case-based Group)

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ADMINISTRATION &

MANAGEMENT

ADMINISTRATION &

MANAGEMENT

• Administered by BPJS Kesehatan (single payer)

• BPJS Kesehatan: managing members, healthcare providers, claims,

complaints, etc

• Government: (MoH, MoF, DJSN), regulates, monitors and evaluate implementation

• _{MoH :}_{sets regulations on delivery of} health services, drug and medical

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NATIONAL HEALTH INSURANCE

Regula tor Regula tor BPJS Kesehata n BPJS Kesehata n Member s Member s Healthca re provider s Healthca re provider s

utilization of service Delivery of service

Regulation on delivery of health

services

Regulation on delivery of health

services

Regulation on Quality of care, HR,

Pharmaceutical, etc

Regulation on Quality of care, HR, Pharmaceutical, etc Regulation on standardization of tariff Regulation on standardization of tariff Government Government Referral system Referral system

MINISTER OF HEALTH

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TASK FORCES:

Preparing For National Health Insurance

1.Health facilities, referral system & infra-structure

2.Finance, transformation of program & institutions, as needed

3.Regulations

4.Human resources & capacity building

5.Pharmaceutical & medical devices

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Preparations

in line with roadmap/ action plan

Task force Tasks

1. Health facilities, referral

system, and infrastructur e



Preparation of health care providers



Strengthening of referral system

by regionalization



Procurement of medical devices

Ratio:

Medical doctor : 40/100.000

Dentist : 11/100.000 Midwives :

75/100.000: 4/PHC Nurses :

158/100.000: 6/PHC

Total hospital : 2.138 hospitals

Total bed : 264.303 beds

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Preparations

in line with roadmap/ action plan

Task force Tasks

2. Finance, transformatio n of

programs and institutions, as needed



Setting premiums and tariffs



Preparing transformation of

existing insurance &

programs : Jamkesmas, Askes PNS, TNI Polri & JPK Jamsostek to Nat Soc Health Ins



Preparing transformation/

migration of management PT

Askes → BPJS Kesehatan

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Task Force Tasks

Regulation – regulatory infrastructur e to support

imple-mentation

• Dev of Government Decree No

101/2012 on Beneficiaries of Government subsidy (PBI)

• Pres Decree No 12/2013 on Social Health Insurance

• Other Decrees (Presidential & Gov)

• MoH decrees, regulations, and procedures for management of

National Health Insurance Scheme

4. Human resources

and capacity building

• Developing HR mapping,

distribution, and assignment

• Design and carrying out training,

as needed ₂₆

Preparations

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Task Force Tasks

5.Pharmace utical and medical devices

• Setting formularies for drugs and medical devices

• Developing e-catalogue

• Forming Health Technology

Assessment (HTA) team and their tasks

Socialization and

advocacy

• Preparing strategy, materials

,and media for socialization of the new National Social Health Insurance scheme

• Conducting intensive and

wide-4

Preparations

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HOW TO ENROLL?

Registration:

1. BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices)

2. Online registration  www.bpjs-kesehatan.go.id

3. Mobile customer services HOTLINE: 500400

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Launching of the National

Health Insurance Scheme and

BPJS Kes

Launching of the National

Health Insurance Scheme and

BPJS Kes



_{31 December: Year-end}

Message President SBY



_{1 Jan 2014:}

• _{Simultanious launching in all}

Provinces, Cities and

Districts by Governor/ Mayor/

District Head

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 _{Indonesia’s National Social Health Insurance}

wil be launched on 1 Jan 2014 → legal basis

from Constitution of 1945 to new regulations and decrees, as needed

 _{Coverage of National Health Insurance will}

expand gradually → Universal Coverage in 2019

 _{Implementation} _of _National _Health

Insurance calls for reforms, in both delivery of health services and health financing.

Preparation well advanced for 1 January 2014 launch

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Task Force Tasks

5.Pharmace utical and medical devices

• Setting formularies for drugs and medical devices

• Developing e-catalogue

• Forming Health Technology Assessment (HTA) team and their tasks

Socialization and

advocacy

• Preparing strategy, materials

,and media for socialization of the new National Social Health Insurance scheme

• Conducting intensive and wide-reaching socialization and

advocacy 27

Preparations

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HOW TO ENROLL?

Registration:

1. BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices)

2. Online registration  www.bpjs-kesehatan.go.id

3. Mobile customer services HOTLINE: 500400

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Launching of the National

Health Insurance Scheme and BPJS Kes

Launching of the National

Health Insurance Scheme and BPJS Kes

_{31 December: Year-end}

Message President SBY

_{1 Jan 2014:}

• _{Simultanious launching in all} Provinces, Cities and

Districts by Governor/ Mayor/ District Head

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 _{Indonesia’s National Social Health Insurance}

wil be launched on 1 Jan 2014 → legal basis from Constitution of 1945 to new regulations and decrees, as needed

 _{Coverage of National Health Insurance will}

expand gradually → Universal Coverage in 2019

 _{Implementation} _of _National _Health

Insurance calls for reforms, in both delivery of health services and health financing.

Preparation well advanced for 1 January 2014 launch

30 CONCLUSION

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