PRESENTATION: The Indonesian National Health Insurance Reform

8/10/2019 PRESENTATION: The Indonesian National Health Insurance Reform

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Universitas ndonesia, Center for Health Economics and Policy Studies

The Indonesian National Health

Insurance ReformHasbullah Thabrany

Chairman, Center for Health Economics andPolicy Studies, Universitas Indonesia (CHEPS UI)

Email: [email protected]

Universitas ndonesia

, Center for Health Economics and Policy Studies

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect

the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they

represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility forany consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
mailto:[email protected]:[email protected]


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+ 3,200 miles

IndonesiaPop 243 million GDP/Capita US + 4,000

24-Nov-14H Thabrany-CHEPS UI 2

Indonesia is such a big country, is it possible?


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Key General and Health Indicators

24-Nov-14 H Thabrany-CHEPS UI3

Indicators

2005 2006 2007 2008 2009 2010 2011Population (M) 227 230 232 235 237 240 242

Gross Domestic Products

(IDR T)

2.774 3.339 3.951 4.949 5.606 6.436 7.427

Total Health Expenditures

(IDR T)

78 98 124 141 160 190 215

IDR 2 USD exchange 9.705 9.159 9.141 9.699 10.390 9.090 8.770

IDR2 Purchasing Power

Party exchange

3.934 4.348 4.701 5.435 5.822 6.223 6.566

GDP per capita (IDR 000) 12.205 14.523 16.996 21.063 23.614 26.832 30.649

Total Health Expenditures

/Cap (IDR)

345 427 533 599 675 794 887

GDP per capita - USD 1.258 1.586 1.859 2.172 2.273 2.952 3.495

Total Health

Expenduture/Cap USD

36 47 58 62 65 87 101

Total Health Expenditure

/Cap (PPP/Int $)

88 98 113 110 116 128 135


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The Indonesian Population Pyramids: 19702025

Higher Health Risks due to Aging Society Need Insurance

At the Same Time, Productive Populations are Increasing



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24-Nov-146


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The Pre UHC Conditions

1. Most people could not afford expensivetreatments of, mostly non-communicablediseases.

2. Total health expenditure low, because lack ofaccess to medical care.

3. Distribution of health care providers andprofessional have been concentrated in largecities

4. Drugs consumptions and quality of medical carewere poor. Market access initiatives by PharmaCompany were necessary



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Public Health Expenditures, % THE,1995-2011.

Some Countries

20

30

40

50

60

70

80

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

High income

Low income

Lower middle income

Middle income

North America

OECD members

Thailand

Malaysia

Indonesia

Sources:

World Bank, 2013

Hasbullah Thabrany

%


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Annual Health Expenditure per Capita USD,

1995-2011, Some Countries

0

50

100

150

200

250

300

350

400 Low income

Lower middle income

Middle income

Thailand

Malaysia

Indonesia

Source: WB, 2013

Hasbullah Thabrany

USD


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24-Nov-14

Previous Health Insurance Systems


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24-Nov-1411

Health Insurance Coverage in 2013


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1224-Nov-14

The Reform begins with mobilzing resources,pooling previously public insurance/public

assistance programs into a single fund


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24-Nov-1413


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24-Nov-1414


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24-Nov-1415


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24-Nov-1416


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f H l h d l d


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f H l h d l d


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f H l h i d li di


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C f H l h i d li S di


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Current Problems

1. The majority of new enrollees are fromindividuals who have been suffering fromchronic diseases. Higher than expectedexpenditures. In private insurance, it is adverse

selection2. Understanding of the complete system, by

providers, local governments, and citizens hasbeen inadequate. Created many complaints and

dissatisfaction.3. Most complaints are on drugs. The E-catalog has

not been understood well by the stakeholders


C t f H lth E i d P li St di


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Roots of the Problems

1. The main cause is the level of contribution settoo low. Mainly, political resistance

2. Payments (capitation and CBGs) are inadequate

for private sector. For the public providers, it isok.

3. Expensive/originator drugs are not reimbursedadequately. Some market access programs are

still helpful4. Misdistribution of health care providers and

health care professionals in small provinces




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Predicted Impacts

1. Demand for health care will increase by 50-100% of the current level. Demand for drugs andexpensive procedures will increase more

2. Health care expenditures will be double in thenext five years, creating more employments andinvestments in health care

3. Redistribution of health care facilities andpersonnel to underserved areas

4. However, moral hazards will be controlled5. Competition will be very though and open




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Previous Trend in THE, 1995-2010


0

20

40

60

80

100

120

140

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

ARIMA HE PPP-3 YMA

ARIMA HE PPP-3 YMA

Center for Health Economics and Policy Studies


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Three Scenarios of Future per Capita

Health Expenditures, Int$


0

200

400

600

800

10001200

1400

1600

1800

2000

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

2029

HE PPP-3 YMA 7% grow

HE PPP-3 YMA 10% grow

HE PPP-3 YMA Insur

effect 10% grow

Center for Health Economics and Policy Studies


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HTh b CHEPSUI 2724-Nov-14 27

PRESENTATION: The Indonesian National Health Insurance Reform

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