MOVING TOWARDS
UNIVERSAL HEALTH ACCESS IN
INDONESIA
Dr. Nafsiah Mboi, Sp.A, MPH Minister of Health
MINISTER OF HEALTH REPUBLIC OF
OUTLINE
1. INTRODUCTION
1. INTRODUCTION
2. EXISTING HEALTH INSURANCE IN INDONESIA
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
4. CONCLUSION
About
Indonesia
World’s largest archipelago
– 17,000 islands
World’s 4
thmost populated
nation - 230 million
people, unevenly
distributed
World’s largest Moslem
population
Strong cultural and
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
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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3 1
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COMPONENTS OF
SOCIAL SECURITY SYSTEM
Health Insurance
Accident insurance
Life insurance Public pension
SOCIAL SECURITY CONCEPT
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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
2.
EXISTING HEALTH
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
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
EXISTING HEALTH INSURANCE COVERAGE
(JUNE 2013)
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3. POLICY & DESIGN OF NATIONAL HEALTH INSURANCE
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
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%
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
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 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 KesehatanLevel 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
MEMBERSHIP
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
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
5%
(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
BENEFIT PACKAGES
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
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
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)
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
NATIONAL HEALTH INSURANCE
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
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
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 systemby regionalization
Procurement of medical devicesRatio:
Medical doctor : 40/100.000
Dentist : 11/100.000 Midwives :
75/100.000: 4/PHC Nurses :
158/100.000: 6/PHC
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 ofexisting insurance &
programs : Jamkesmas, Askes PNS, TNI Polri & JPK Jamsostek to Nat Soc Health Ins
Preparing transformation/migration of management PT
Askes → BPJS Kesehatan
Task Force Tasks
3.
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
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Preparations
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
6.
Socialization and
advocacy
• Preparing strategy, materials
,and media for socialization of the new National Social Health Insurance scheme
• Conducting intensive and
wide-4
Preparations
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
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
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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