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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]8/10/2019 PRESENTATION: The Indonesian National Health Insurance Reform
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Universitas ndonesia, Center for Health Economics and Policy Studies
+ 3,200 miles
IndonesiaPop 243 million GDP/Capita US + 4,000
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Indonesia is such a big country, is it possible?
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Key General and Health Indicators
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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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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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Previous Health Insurance Systems
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Health Insurance Coverage in 2013
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The Reform begins with mobilzing resources,pooling previously public insurance/public
assistance programs into a single fund
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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
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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
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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$
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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