UNIVERSAL HEALTH ACCESS IN INDONESIA Dr Nafsiah Mboi SpA MPH Minister of Health Republic of Indonesia MINISTER OF HEALTH REPUBLIC OF INDONESIA 1 OUTLINE 1 INTRODUCTION 2 EXISTING HEALTH INSURANCE IN INDONESIA ID: 461505
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MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA
Dr. Nafsiah Mboi, Sp.A, MPHMinister of HealthRepublic of Indonesia
MINISTER OF HEALTH
REPUBLIC OF INDONESIA
1Slide2
OUTLINE
1.
INTRODUCTION
2.
EXISTING HEALTH INSURANCE IN INDONESIA
3.
POLICY & DESIGN
OF
INDONESIA’S NATIONAL
HEALTH INSURANCE SCHEME
4. CONCLUSION
2Slide3
1. INTRODUCTION
3Slide4
About Indonesia
World’s largest archipelago – 17,000 islands World’s 4th most populated nation - 230
million people, unevenly distributed
World’s largest Moslem population Strong cultural and religious valuesSlide5
INDONESIAN HEALTH FINANCING 2011
GDP per capita US$ 3,494Total
Health Expenditure
Rp 214,9 Trilli
on,
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 insurance (various schemes),
28
%
of population
uninsuredSlide6
National Social Security System
L
aw
No. 40/2004
The essence:
To s
ynchroni
z
e implementation of social security in Indonesia
The purpose:
To guarantee protection and social
welfare for all people
6Slide7
4
2
3
1
5
Components of
Social Security
system
Health
Insurance
A
ccident
insurance
Life
insurance
Public pension
Old age pension
7Slide8
Social Security Concept
4
2
3
1
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All
employed citizens
(in formal or informal sectors)
who
have
income shall contribute to the program
B
asic
benefits
guaranteed
Those who
wish
more protection
,
are free to purchase additional services
o
n commercial basis
Planned, phased
implementation
5
Government
i
s
regulator
8Slide9
2.
EXISTING HEALTH INSURANCE IN INDONESIA
9Slide10
Some Short Comings inEXISTING HEALTH INSURANCE SCHEMES
Lack of integration in implementation and coverage.Fragmented fund-pooling & management
Different
benefit packages and limits among schemesVariations in management systems of different providers
Limited and uneven monitoring, evaluation and coordination among schemesSlide11
EXISTING HEALTH INSURANCE COVERAGE
Coverage : June 2013176.844.161 people covered (72 % of population) JAMKESMAS :
86.400.000
(36,3 %)JAMKESDA : 45.5
95.520 (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 %)
11Slide12
EXISTING HEALTH INSURANCE
COVERAGE
(JUNE 2013)
12
36.3
28Slide13
3. POLICY & DESIGN OF
NATIONAL HEALTH INSURANCE (STARTING FROM 1 JANUARY 2014)
13Slide14
LEGAL
FOUNDATION FORINDONESIA’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 Other regulations
14Slide15
ROADMAP TO UHC
20%50%75%100%
20%
50%75%100%10%
30%50%70%100%
100%
`
Enterprises
2014
2015
2016
20172018
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
(
JPK Jamsostek, Jamkesmas, Askes PNS, TNI Polri
)
Membership expansion to big, middle, small and micro enterprises
Procedure setting on membership and contribution
Company mapping and socialization
Consumer satisfaction measurement every 6 month
Integration of
Jamkesda
in
to BPJS
Kesehatan
and
regulation of
commercial insurance
industry
Pengalihan Kepesertaan TNI/POLRI ke BPJS Kesehatan
Benefit package and
sevices
review annually
Synchronization membership data
: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial –
single identity number
Coverage of various existing schemes
148,2
mio
1
21
,
6
mio covered by BPJS Keesehatan50,07 mio covered by other schemes257,5 mio (all Indonesian people) covered by BPJS KesehatanLevel of satisfaction 85%Activities: Transformation, Integration, Expansion
B
SK73,8 mio uninsured people
Uninsured people 90,4
mioPresidential decree on operational support for Army/Police
8
6,4 mio PBI
15Slide16
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 Indonesia for 6 months or longer.
16Slide17
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 Jun
e
2015
:
0,5%
from employee
4% from employer
Start from 1 Jul
y
2015
:
1%
from employee
4% from employer
Class 1
&
2 IP care
NON WAGE EARNERS/ INDEPENDENT MEMBERS
NOMINAL
(per member)
1. 25,500,-
2. 42,500,-
3. 59,500,-
Class
3 IP care
Class
2 IP care
Class
1 IP care
17Slide18
BENEFIT PACKAGE
SBenefit package : personal health care covering promotive
, preventive, curative & rehabilitative services
Benefit package : includes both medical & non medical,
such as hosp accommodation, ambulance etc
R
egulat
ion
stipulates services covered
18Slide19
FINANCE
: CONTRIBUTION (PREMIUM)Contribution for
people below the poverty line (
PBI)→ paid by central (and local) government
Contributions of members paying their own premium
Workers in formal employment
: premium is shared by employees
and employer
calculated
as a % of salary/wage. Self and non
employed: pay nominal/ flat rate (determined by Pres Decree)
Contributions/ premiums are pooled and create the major source of funding for the scheme
19Slide20
HEALTH
CARE PROVIDERS AND PAYMENT METHODSHealthcare providers
Primary health care providers: Public Health Service, Private
clinics, Primary Care Doctors
Secondary & tertiary health care providers: Hospitals both public hospitals and private hospitalsPayment methodsPrimary
health care providers
:
capitation & non
capitation
Secondary and tertiary health care providers: Ina-CBG’s (Case-based Group)
20Slide21
ADMINISTRATION &
MANAGEMENTAdministered by BPJS Kesehatan (single payer)
BPJS
Kesehatan: managing members, healthcare providers, claims
, complaints, etcGovernment:
(
MoH
,
MoF, DJSN), regulates, monitors
and evaluate implementationMoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc
21Slide22
NATIONAL HEALTH INSURANCE
Regulator
BPJS Kesehatan
Members
Healthcare providers
Contribution
Complain management
Contract
Claims
Payment
utilization of service
Delivery of
service
Regulation on delivery of health services
Regul
ation
on Quality of care, HR, Pharmaceutical,
etc
Regula
tion
on standardization of tariff
Government
Referral system
MINISTER OF HEALTH
22Slide23
TASK FORCES: Preparing
For National Health Insurance Health facilities, referral system & infra-structure
Finance
, transformation of program & institutions, as neededRegulationsHuman resources & capacity buildingPharmaceutical
& medical devicesSocialization & advocacy
23Slide24
Preparations in line with roadmap/ action plan
Task force
Tasks
1.
Health facilities, referral system, and infrastructure
Prepar
ation of
health
care providers
Strengthening of referral system by 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
Total hospital :
2.138 hospitals
Total bed :
264.303 beds
24
1Slide25
Preparations in line with roadmap/ action plan
Task force
Tasks
2.
Finance, transformation of programs and institutions, as needed
Setting
premiums
and tariffs
Preparing
transformation of existing insurance & programs :
Jamkesmas, Askes PNS, TNI Polri & JPK Jamsostek to Nat Soc Health Ins
Preparing transformation/ migration of management PT Askes → BPJS Kesehatan
25
2Slide26
Task Force
Tasks
3.
Regulation – regulatory infrastructure 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 InsuranceOther Decrees (Presidential & Gov)
MoH decrees, regulations, and procedures for management of National Health Insurance Scheme
4. Human resources and capacity buildingDeveloping HR mapping, distribution, and assignmentDesign and carrying out training, as needed
26
3
Preparations
in line with roadmap/ action pl
anSlide27
Task Force
Tasks
5.
Pharmaceutical and medical devices
Setting
formularies
for
drug
s
and medical devicesDeveloping e-catalogueForming Health Technology Assessment (HTA)
team and their tasks
6. Socialization and advocacyPreparing strategy, materials ,and media for socialization of the new National Social Health Insurance schemeConducting intensive and wide-reaching socialization and advocacy
27
4
Preparations
in line with roadmap/ action pl
anSlide28
HOW TO ENROLL?Registration:
BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices)Online registration www.bpjs-kesehatan.go.idMobile customer services
HOTLINE: 500400
28Slide29
Launching of the National Health Insurance Scheme and BPJS Kes
31 December: Year-end Message President SBY1
Jan 2014:
Simultanious launching in all Provinces, Cities and Districts by Governor/ Mayor/ District Head
29Slide30
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
30
CONCLUSIONSlide31
Thank YouSlide32