Preventive Health Programs in Social Health Insurance english final (3)

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Preventive Health Programs in

Social Health Insurance

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Epidemiological Transition

Source : Double Burden of Diseases & WHO NCD Country Profiles (2014)

Causal of Death, 1990-2015

Cedera; 7%

Penyakit Tidak Menular; 37% Penyakit Menular; 56%

Cedera; 8%

Cedera; 9%

1990 2000 2010 2015

Cedera; 13%

No Causal of Death %

1 Stroke (I60 - I69) 21.1

2 Coronary Heart Disease (I20 – I25) 12.9

3 Diabetes mellitus with complication (E10 –

E14) 6.7

4 Tuberkulosis (A15 – A16) 5.7

5 Hipertension with complication (I11 – I13) 5.3

6 CPOD (J40-J47) 4.9

7 Hepatitis/liver Diseases (K70 – K76) 2.7

8 Injury (V01– V99) 2.6

9 Pneumonia (J12 – J18) 2.1 10 Diarrhea and GIT infections (A09) 1.9

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HiGH COST/expenditure on the treatment of diseases

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Source: BPJS Kesehatan, 2014

Total number of impatient CVD is ranked 4th, however the expenditure is the highhest (3.5 Trillion IDR) pembiayaannya menyerap biaya tertinggi (3,5 T)

173,936

PARACIYE AND INFECTION

CARDIOVASCULAR DISEASES

RESP IRATORY DISEASES DELIVERIES/LABOR

WOMEN REP RODUCTIVE

SKIN DIS-EASES

Top 10 Diseases

Claimed of Impatient Year 2014: NHI , total Top 10 Diseases Claimed as Outpatient Biaya Klaim Penyakit Rawat Inap

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Health

Paradigm

Health

Paradigm

Program

• Health in all Policies

• Promotive-Preventive as main Pillar of Health

• Community empowerment

Strengthening Health Delivery

System

Strengthening Health Delivery

System

Program

• _{Increase access at}

Primary care

• _{Optimalization of}

Referral system • _{Benefit package} • _{Insurance Financing}

System  Gotong royong

• _{Quality Assurance}

and quality control

• _{Target: fully}

Subsidized & Non Subsidized

Membership card

Indonesian Health card

National Health Strategic Plan

2015-2019

National Health Strategic Plan

2015-2019

continuum of care

Health risk assessment intervention

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Strategic opportunity INCREASE HEALTH BUDGET from 2,5 TO 5%

DIRECTED TO BREAKTHROUGH PRIORITY PROGRAM TO BOOST THE ACHIEVEMENT OF NATIONAL DEVELOPMENT INDICATORs

• HEALTH REGULATION LAW 36/2009

• DECENTRALIZATION LAW 23/2014

• GOVERNMENT

REGULATION 109/ HEALTH MINISTER REGULATION

LIFE CYCLE APPROACH

1.INTEGRATED AND COMPREHENSIVE HEALTH DELIVERY SYSTEM

2.INTEGRATED DRUG MANAGEMENT SYSTEM

3.REACHING OUT THE UNREACH 

FAMILY FOLDER APPROACH

4.INTEGRATED PLANNING AND EVALUATION

5.INCREASE EVIDENCE BASE INTERVENTION

INCREASING NATIONAL HEALTH STATUS

DECREASE MMR AND IMR

DECREASE MORBIDITY AND MORTALITY FROM ATM (AIDS, TB, MALARIA)

DECREASE Stunting DECREASE

Stunting

DECREASE MORBIDITY AND EARLY MORTALITY DUE TO NCDS (CVD, DIABETES, CPOD, CANCER,

OBESITY)

DECREASE MORBIDITY AND EARLY MORTALITY DUE TO NCDS (CVD, DIABETES, CPOD, CANCER,

OBESITY)

PROMOTION AND CONTROL OF RISK FACTOR

SUPPORTING EFFORTS

CONDUCIVE ENVIRONMENT

STRENGTHENING PRIMARY, SECONDARY AND TERTIARY PREVENTION

INCREASE ACCESS TO QUALIFIED HEALTH SERVICE DELIVERY (Continuum of Care)

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NCD, CD, MCH Global Targets included as National Development Targets

in the Medium-term National Development Plan 2015-2019

1. Reduction of Raised Blood Pressure from 25,8% (2013) to 23,4% (2019)

2. Halt the rise of prevalence of Obesity from age 18+ years (at 15,4%)

3.Relative reduction of current tobacco consumption at age < 18, from 7,2 (2013) to 5,4 (2019)

4. Prevalence of TB, from 280/100,000 in 2015 to 245/100,000 in 2015

5. Prevalence of HIV maintain below 0.5%

6. Decreasing MMR (maternal Mortality Rate)

7. Decreasing IMR (Infant Mortality Rate)

Strategic policy approach 

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Policy for promotive preventive measures in ncd

control

• Health Minister Regulation no

71/2015 on NCD Control

•

MOH Strategic Plan indicator

•

Percentage of villages that have POSBINDU PTM/ NCD CBI

•

Draft of Government Regulation (RPP) on Minimum

Standard of Services at Districts/Cities (SPM) Standar Pelayanan Minimal Bidang Kesehatan Di Kabupaten Kota

•

Standard Health Screening at age 15-59 years (once/year)

•

Standard Health Screening at age 60 years above (once/year)

•

Access to Standardize case management for Hypertension

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Family Health Approach

Primary care

family

Community NCD CBIs, Health Posts, School Health, etc

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3. First promotive preventive Approach

Keeping Healthy people healthy

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POSBINDU PTM

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BACKGROUND

•

Prevalence of Common Risk Factors (Smoking, AlcoHol Consumption,

physical inactivity, unhealthy diet) for NCDs are increasing and alarming 

without any intervention people with common risk factors will turn to either DM, Hypertension, Cardiovascular Disease, COPD and Cancer

•

2/3 cases of NCD (in particular DM and Hypertension) are still undiagnosed 

increase comorbidity and complications at point of services

•

The increasing trend of major NCDs (DM, CVD, COPD, Cancer) if not tackled immediate will have the implication on the quality of human resource,

increasing health cost/expenditure and creating economic burden to the nation

•

NCD cases are chronical diseases and creating lots of comorbidity and

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Goal Of NCD CBI

1.

To reach the healthy people at the community age 15-59 years and 60 above to do routine standard health screening at least once a year and increase

access to promotive preventive intervention at community level (Posbindu PTM) with the ultimate goal to keep healthy people healthy.

2.

To reach the people who identify themselves as healthy but already having NCD high risk factors to be earliest detected and admit in intevention package for behavior risk modification at individual, group or community movement.

3.

To reach out undiagnosed NCD cases in the community and detecting at the earliest stage of NCD (pre-Diabetes or Hypertension)

4.

To enforce the people who are detected as having earliest form of NCD to be referred at Primary Health care to receive standardize treatment

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Posbindu PTM at multiple Setting

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BODY FAT ANALYZER

HEIGHT MEASUREMENT

TENSIMETER

WAIST CIRCUMFERENCE

NCD CBI KIT

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Activities At NCD CBI

Activities

5 Activities 4

Activities

nutrition / physical activity therapy

Secondary screening:

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REFERRAL SYSTEM

POSBINDU PTM



Primary Health Center

Early Detection of common risk factorsEarly Detection of

common risk factors

Intervention behavior/ lifestyle

modification

At individual, group and community

Intervention behavior/ lifestyle

modification

At individual, group and community

Observe the changes in 3-6 months

If no change

Refer to PHC Refer to PHC

Criteria for Blood Glucose screening :

IMT>23,age >40, family history on DM,/ other NCD BB lahir lebih 4kg, Lingkar perut >80(P), >90(L), having symptom of TB or known as TB

patients

Criteria for Blood Glucose screening :

IMT>23,age >40, family history on DM,/ other NCD BB lahir lebih 4kg, Lingkar perut >80(P), >90(L), having symptom of TB or known as TB

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Source of Funding

•

Self reliance (from the community)

•

CSR (Corporate Society Responsibility )

•

Central and Local government scheme (Dekon dan DAK)

•

Allocated funding for SPM at District

•

Village Funding

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Second promotive preventive Approach

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CARTA WHO/ISH

INTEGRATED APPROACH TO NCD (PEN)

 _{Goal: to increase NCD case detection}

and management of major risk factors (Stop Smoking Counseling, decrease consumption of alcohol , decrease Hypertension, Hyperglicaemia, Obesity, Dislipidemia) at Primary

Health Care Setting (Puskesmas and other facilities)

 _{Target: 100 % of people >15 are}

reached by Posbindu PTM to receive standardize health screening at least once a year (SPM Health)

 _{Integrated Case Management od}

Hipertension and Diabetes conducted through Risk Factors approach and Risk prediction of CVD and Stroke using Charta WHO-PEN

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www.ptaskes.com Paparan Resmi PT Askes (Persero)

Primary Preventive screening

Secondariy preventive screening

Healthy Life style (education, nutrition intervention, physical

activity/excercise))

Risiko Tinggi

Health/ Lower risk

SECONDARY AND TERTIARY CASE MANAGEMENT

(Chronical Disease Management Program  PROLANIS  PPDM - PPHT

Chronical Disease Diagnosis

PRIMARY PREVENTION

• HEALTHY LIFE STYLE MOVEMENT

• COUNSELLING

High Risk but Un-diagnosed as Chronic

Risk factors classication

Medical grouping diagnosis classification

JKN Card Holder: increaseing benefit 0f Promotive & Preventive packages, Increasing access to quality health services BPJS : Grouping and prevention of Disease risks & expenditure control strategy

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Chronical Disease Management

Supported by Professional Organization and Mobile Apps data recording System

Participant join and actively engaged in Prolanis health Club

Back Referral program

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Specialists’ Mentoring

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Specialist Doctor have a role as “Supervisor” for several primary care services (FKTP) at their coverage areas: 1. Case Studies of Chronical Disease

2. Workshop to improve the capacities in reading EKG, Rontgen resolts etc

3. Evaluation of Patients condition at Primary Care setting (FKTP)

4. Networking of Back Referral Program

Supported by related professional organizations: PERKENI, PAPDI, PERNEFRI, PERKI, etc

Standardized and Increase competencies of Primary Care Physician

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Back Referral Program

Program Rujuk Balik (PRB) for:

1. Diabetes mellitus

2. Hypertension

3. CVD

4. Ashma

5. Chronic Obstructive Pulmonary Disease (COPD)

6. Epilepsy

7. Mental Health

8. Stroke, and

9. Systemic Lupus Eritematosus (SLE)

10. Other Chronical disease determine by MoH and Professional organization

“Mandatory” if the condition of patients already stabile, certified with “Letter for Back Referral signed by Specialist or

subspecialist

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