Post on 17-Jan-2016
MOVING TOWARDS UNIVERSAL HEALTH
COVERAGE IN INDONESIA
11th ASEAN and Japan HLOM on Caring Societies
Panel Discussion:
Universal Health Coverage as a basis for ‘Active Aging’ and Medical and Welfare
Services, Health Promotion, and Disease Prevention
Number of Island: 17,504 Population, 2012 ± 246,9 millionGDP per Capita 2012 (in USD): 3,592 Decentralized Government: 34 provinces; 508 districtsLife Expectancy Life Expectancy 70,970,9 years years (2010)(2010) Number of population 60+ years in Indonesia will increase from 18.1 million in 2010 to 29.1 million in 2020 or approximately 11.4% of the total population and 36 million in 2025. Now number of the elderly has reached about 23 million.
INDONESIA
CURRENT HEALTH INSURANCE COVERAGE BY
2013
EXISTING HEALTH INSURANCE PROGRAM IN INDONESIA
1. Disintegrated implementation and coverage
2. Fragmented fund pooling & management
3. Limited & variations of benefit among schemes
4. Variations of carriers management
5. Lack of monitoring, evaluation and coordination among schemes
POLICY FRAMEWORK AND EXPERIENCE ON INCREASING ACCESS TO HEALTH SERVICES FOR INDONESIAN
5
• Constitution• Act No 40/2004• Act No 24/2011• Govt decree No 101/2012• Presidential decree No 12/2013, others
-External factors- Internal factors
Existing Situation:1.Disintegrated implementation and coverage2.Fragmented fund pooling & management3.Limited & variations of benefit among schemes4.Variations of carriers management 5.Lack of monitoring, evaluation and coordination among schemes
Strategy:1. Synchronisation &
integration of schemes
2. Improve fund pooling
3. Optimising benefit package among schemes
4. Development of single carriers
5. Strengthen coordination, monitoring & evaluation
Efforts:
6 task forces:1. Regulation
2. Financing and Program transformation
3. Health Facilities, Referral System & Infrastructure
4. HR of health
5. Pharmaceutical and medical devices
6. Socialization
ExistingHealth
InsuranceCoverage
Universal Health
Coverage
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%
Transformation from 4 existing schemes to BPJS Kesehatan
(employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme)
Transformation from 4 existing schemes to BPJS Kesehatan
(employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme)
Membership expansion to big, middle, small and micro enterprises
Membership expansion to big, middle, small and micro enterprises
Procedure setting
on membership and contribut
ion
Procedure setting
on membership and contribut
ion
Company mapping
and socializat
ion
Company mapping
and socializat
ion
Consumer satisfaction measurement every 6 month
Consumer satisfaction measurement every 6 month
Integration of Jamkesda into BPJS Kesehatanand regulation of commercial insurance industry
Integration of Jamkesda into BPJS Kesehatanand regulation of commercial insurance industry
membership transfer of
army/police scheme to BPJS
Kesehatan
membership transfer of
army/police scheme to BPJS
Kesehatan
Benefit package and sevices review annually Benefit package and sevices review annually
Synchronization membership data: JPK
Jamsostek, Jamkesmas dan Askes PNS/Sosial – single
identity number
Synchronization membership data: JPK
Jamsostek, Jamkesmas dan Askes PNS/Sosial – single
identity number
Coverage of various existing schemes
148,2 mio
Coverage of various existing schemes
148,2 mio
111,6 mio covered by
BPJS Keesehatan
111,6 mio covered by
BPJS Keesehatan60,07 mio covered by
other schemes
60,07 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
BMS
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
6
BENEFIT PACKAGE
• Personal health care covering promotive, preventive, curative & rehabilitative services.
• The benefit incudes both medical and non medical concerns such as hospital accommodation, ambulance, etc
• Regulation stipulates services covered
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EXCLUSIONS (1)
• Health care without going through the procedures
• Health services in health facilities that is not contracted with BPJS
• Health services which is covered by covered by occupational accident insurance
• Health services abroad• Health services for aesthethic purposes• Health services for infertility (to have
children)• Orthodontic• Health disorders/diseases caused by drugs
addictions
8
EXCLUSIONS (2)
• Health problems related caused by activity endager himself
• Complementary treatment , alternative and traditional medication , including accupaucture, shin she, chiropractic and others that have not been declared by HTA
• Experimental medical treatment• Contraseptives, cosmetics, baby foods and milk• Health equipment for household• Health services for disaster situation• Another services which is not associated with
health insurance benefits 9
ADMINISTRATION AND MANAGEMENT
• Administered by BPJS Kesehatan (single payer)
• BPJS Kesehatan: managing members, healthcare providers, claims, complaints, etc
• Government: (MoH, MoF, DJSN) monitor and evaluate implementation
• MoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc
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JAMKESMAS EXPERIENCE FOR ELDERLY MEMBERSHIP
PROPOSED RECOMMENDATION
Increase an ability to provide our citizens with quality health care through systems that are sustainable and responsive to the health problems and health care demands, including an increasing number of elderly.
Committed to provide our community with access to comprehensive and quality universal health coverage (UHC) as an investment in future socio-economic well-being. Promote regional activities on sharing information and best practices in reducing the burden of disease and cost of care as well as in focusing health promotion and disease prevention to respond an increasing trends of non-communicable disease as populations’ age and life styles change.