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HOSPITAL STRATEGY IN THE ERA OFUNIVERSAL HEALTH COVERAGE
Dr.dr.Sutoto,M.KesChairman of the Indonesian Hospital Association
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CORE DISCUSSION
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5 FIVE) INDICATIONS OFWHY INDONESIA WILL BE THE 7TH LARGESTECONOMY IN THE WORLD1. Stable economic growth and forecast
2. Growth in urbanization. 90% of the national economic growth
SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS
3. 11% of export is not from natural resources (oil and gas)
4. 7% decrease in labor intensive industries.
5. 60% of the economy is due to the increase in productivity
Resource: McKinsey Global Institute presentation by Chairman Raoul Oberman, Indonesias Vision for 2030 ,
Indonesias National Economic Committee, Ritz Carlton Hotel, 13/11/13
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G 20 MEMBERS
Ist: ECONOMIC LEVEL of INDONESIA IS ASSESSED ASMOST STABLE IN WORLD
90 % WORLD GDP 80 % totalWORLD COMMERCE
2/3 % WORLD POPULATION
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DEVELOPMENT Of ECONOMICS OfINDONESIA
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GROWTH OF URBANIZATION90% of the national economic growth is contributed by cities outside of Java
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60 % OF ECONOMIC GROWTH SUPPORTED BYINCREASE IN PRODUCTIVITY
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By 2030: 90 Million Indonesians could join theConsuming Class
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STAGES IN IMPROVING
QUALITY PERFORMANCE
Primitive: You should do X(X= Regulation, Standard, Incentive)
Medieval : You must do X
Modern: X is norm (X= Check list, Default, Feed back,Loops ex: CP)
Future : X is done (automation)
AtulGawande, MD, Plenary Speaker, ISQuaInternational Conference 14 Oct 2013. Edinburgh, Scotland
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THREE DIMENTION TOWARDUNIVERSAL HEALTH COVERAGE
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WHAT DO PEOPLE HAVE TO PAY OUT OF POCKET?
Around 150 million people suffer financial catastrophe eachear and 100 million ushed into overt because of out-of-
FIRST DIMENSION: FINANCIAL PROTECTION
What do people have to pay out of pocket ? Coverage mechanism VS cost sharing and fee ?
pocket health care bills (1)
Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems
Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services
PAYMENT SYSTEM : CAPITATION FOR PRIMARY CARE CASE BASE GROUP FOR SECONDARY AND TERTIARY CARE
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HOW CAN THE MIDDLE CLASS BENEFITFROM THE UNIVERSAL HEALTH CARE COVERAGE?
COST SHARING TO COVER THEIR DIFFERENT NEEDS
Patients that would like to stay in higher classes can pay thedifference with private health insurance
or out-of-pocket payment,Stated in Ministry of Health regulation PERPRES 12 TTG JAMINAN KESEHATAN. Clause 24
COVERAGE MECHANISM
(PAID BY BPJS)
COVERAGE MECHANISM
(PAID BY BPJS)
COST SHARING
COST SHARING
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SHIFT OF THE PATIENT AND THE ROLE OF HOSPITALSIN THE ERA OF UNIVERSAL HEALTH CARE COVERAGERS BLURS SNRS PT
RS BLURS SN
RS BLURS SNRS PT
PASIEN BPJS
PASIEN BPJS(100% coverage)
PASIEN BPJS(Additionalinsurancecoverage)
PASIEN BPJS(With option topay balance of
payment owing)
(Additional insurance
coverage)PASIEN BPJS(100% coverage)
IUR BIAYA(With option to paybalance of payment
owing)
TAHUN 2014
TAHUN 2019
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TEN LEADING SOURCES OF INEFFICIENCYTEN LEADING SOURCES OF INEFFICIENCY1. Medicine: underuse of generics and higher than necessary price.
2. Medicine: use of substandard and counterfeit medicines.
3. Medicine: inappropriate and ineffective use.
4. Products and services: overuse/ supply of equipment, diagnostic servicesand procedures.
5. Health workers: inappropriate or costly staff mix, unmotivated workers.
. ea servce: nappropr ae osp a a msson an eng o say.
7. Health service: inappropriate hospital size and low use of infrastructure.
8. Health service: medical errors and suboptimal quality.
9. Health system leakages: waste, corruption and fraud.
10. Health intervention: inefficient mix and inappropriate level.
Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems
Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services
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MANAGEMENT SKILL TO CONTROL PHYSICIAN
BEHAVIOUR
POSITIVE ADAPTATIONPROCESS FASTER
TO CONTROL
PHYSICIANBEHAVIOUR
NEGATIVEADAPTATION
PROCESS MORESLOW
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SIX STEPS HOSPITAL STRATEGY TOWARD UHC/JKN
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1.1. Develop: New Standards must be based on the nationalDevelop: New Standards must be based on the national
standards of hospital accreditationstandards of hospital accreditation
OVERALLHOSPITAL STRATEGY IN THE ERA OFUNIVERSAL HEALTH CARE COVERAGE
2.2. Use of : SPOs from the international adapted accreditationUse of : SPOs from the international adapted accreditationstandards,standards, formulariumformularium, Clinical pathways, checklists., Clinical pathways, checklists.
3.3. Train staff competence to execute: new accreditationTrain staff competence to execute: new accreditationstandards, use of checklists, clinicalstandards, use of checklists, clinical pathways,pathways, ICD 10 and ICDICD 10 and ICD
9 CM, INA CGBs and9 CM, INA CGBs and monitoring level ofmonitoring level of compliance withcompliance withreward program.reward program.
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