MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN
INDONESIA
Dr. Nafsiah Mboi, Sp.A, MPHMinister of Health
Republic of Indonesia
MINISTER OF HEALTH REPUBLIC OF INDONESIA
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OUTLINE1. INTRODUCTION
2. EXISTING HEALTH INSURANCE IN INDONESIA
3. POLICY & DESIGN OF INDONESIA’S NATIONAL HEALTH INSURANCE SCHEME
4. CONCLUSION
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1. INTRODUCTION
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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 values
INDONESIAN HEALTH FINANCING 2011
GDP per capita US$ 3,494 Total Health Expenditure Rp 214,9 Trillion,
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 uninsured
NATIONAL SOCIAL SECURITY SYSTEM
LawNo. 40/2004
The essence:To synchronize implementation of social security in Indonesia
The purpose:To guarantee protection and social welfare for all people
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COMPONENTS OF SOCIAL SECURITY SYSTEM
Health Insurance
Accident insurance
Life insurance
Public pension
Old age pension
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SOCIAL SECURITY CONCEPT
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All employed citizens (in formal or informal sectors) who have income shall contribute to the program
Basic benefits guaranteed
Those who wish more protection, are free to purchase additional services on commercial basis
Planned, phased implementation
5 Government is regulator
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2. EXISTING HEALTH INSURANCE IN INDONESIA
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Some Short Comings inEXISTING HEALTH INSURANCE SCHEMES
1. Lack of integration in implementation and coverage.
2. Fragmented fund-pooling & management
3. Different benefit packages and limits among schemes
4. Variations in management systems of different providers
5. Limited and uneven monitoring, evaluation and coordination among schemes
EXISTING HEALTH INSURANCE COVERAGE
Coverage : June 2013176.844.161 people covered (72 % of population)
• JAMKESMAS : 86.400.000 (36,3 %)• JAMKESDA : 45.595.520 (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 %)
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EXISTING HEALTH INSURANCE COVERAGE(JUNE 2013)
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36.328
3. POLICY & DESIGN OF NATIONAL HEALTH INSURANCE (STARTING FROM 1 JANUARY 2014)
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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
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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%
2012 2013 2014 2015 2016 2017 2018 2019Transformation from 4 existing schemes to
BPJS Kesehatan (JPK Jamsostek, Jamkesmas, Askes PNS, TNI Polri )
Membership expansion to big, middle, small and micro enterprisesProcedure setting on
membership and
contribution
Company mapping
and socialization
Consumer satisfaction measurement every 6 month
Integration of Jamkesda into BPJS Kesehatanand 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 148,2mio
121,6 mio covered by BPJS Keesehatan
50,07 mio covered by other schemes
257,5 mio (all Indonesian
people) covered by BPJS
Kesehatan
Level of satisfaction 85%
Activities: Transformation, Integration, Expansion
BSK
73,8 mio uninsured people
Uninsured people 90,4 mio
Presidential decree on operational support
for Army/Police
86,4 mio PBI
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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.
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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 June 2015:0,5% from employee
4% from employer
Start from 1 July2015:1% from employee4% from employer
Class 1 & 2 IP care
NON WAGE EARNERS/ INDEPENDENT MEMBERS
NOMINAL (per member)
1. 25,500,- 2. 42,500,-
3. 59,500,-
1. Class 3 IP care2. Class 2 IP care3. Class 1 IP care
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BENEFIT PACKAGES
• Benefit package : personal health care covering promotive, preventive, curative & rehabilitative services
• Benefit package : includes both medical & non medical, such as hosp accommodation, ambulance etc
• Regulation stipulates services covered
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FINANCE: CONTRIBUTION (PREMIUM)
Contribution for people below the poverty line (PBI)→ paid by central (and local) government
Contributions of members paying their own premium
a. Workers in formal employment : premium is shared by employees and employer calculated as a % of salary/wage.
b. 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
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HEALTH CARE PROVIDERS AND PAYMENT METHODS
Healthcare providers Primary health care providers: Public Health Service,
Private clinics, Primary Care Doctors Secondary & tertiary health care providers: Hospitals
both public hospitals and private hospitals
Payment methods Primary health care providers: capitation & non
capitation Secondary and tertiary health care providers: Ina-
CBG’s (Case-based Group)20
ADMINISTRATION & MANAGEMENT
• Administered by BPJS Kesehatan (single payer)
• BPJS Kesehatan: managing members, healthcare providers, claims, complaints, etc
• Government: (MoH, MoF, DJSN), regulates, monitors and evaluate implementation
• MoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc 21
NATIONAL HEALTH INSURANCE
Regulator
BPJS Kesehatan
Members Healthcare providers
Contr
ibutio
n C
ompla
in ma
nage
ment Contract
Claims
Payment
utilization of service
Delivery of service
Regulation on delivery of health services
Regulation on Quality of care, HR,
Pharmaceutical, etc
Regulation on standardization of tariff
Government
Referral system
MINISTER OF HEALTH
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TASK FORCES: Preparing For National Health Insurance
1. Health facilities, referral system & infra-structure
2. Finance, transformation of program & institutions, as needed
3. Regulations4. Human resources & capacity building5. Pharmaceutical & medical devices6. Socialization & advocacy
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Preparations in line with roadmap/ action plan
Task force Tasks1. Health facilities, referral system, and infrastructure
Preparation of health care providers Strengthening of referral system by
regionalization Procurement of medical devices
Ratio: 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 hospitalsTotal bed : 264.303 beds
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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
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Task Force Tasks3. 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 Insurance
• Other Decrees (Presidential & Gov) • MoH decrees, regulations, and procedures
for management of National Health Insurance Scheme
4. Human resources and capacity building
• Developing HR mapping, distribution, and assignment
• Design and carrying out training, as needed
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3Preparations in line with roadmap/ action plan
Task Force Tasks
5.Pharmaceutical and medical devices
• Setting formularies for drugs and medical devices
• Developing e-catalogue• Forming Health Technology Assessment
(HTA) team and their tasks
6. Socialization and advocacy
• Preparing strategy, materials ,and media for socialization of the new National Social Health Insurance scheme
• Conducting intensive and wide-reaching socialization and advocacy
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4Preparations in line with roadmap/ action plan
HOW TO ENROLL?
Registration:
1. BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices)
2. Online registration www.bpjs-kesehatan.go.id3. Mobile customer services
HOTLINE: 500400
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Launching of the National Health Insurance Scheme and BPJS Kes
31 December: Year-end Message President SBY
1 Jan 2014:• Simultanious launching in all Provinces,
Cities and Districts by Governor/ Mayor/ District Head
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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
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CONCLUSION
Thank You