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MOVING TOWARDS - PPT Presentation

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

insurance health national amp health insurance amp national bpjs 100 social care kesehatan people providers medical indonesia existing premium

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Slide1

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

Add Your Text

Add Your Text

Add Your Text

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