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MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA Dr. Nafsiah Mboi, Sp.A, MPH Minister of Health Republic of Indonesia MINISTER OF HEALTH REPUBLIC OF.

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Presentation on theme: "MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA Dr. Nafsiah Mboi, Sp.A, MPH Minister of Health Republic of Indonesia MINISTER OF HEALTH REPUBLIC OF."— Presentation transcript:

1 MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA Dr. Nafsiah Mboi, Sp.A, MPH Minister of Health Republic of Indonesia MINISTER OF HEALTH REPUBLIC OF INDONESIA 1

2 OUTLINE 1. INTRODUCTION 2. EXISTING HEALTH INSURANCE IN INDONESIA 3. POLICY & DESIGN OF INDONESIA’S NATIONAL HEALTH INSURANCE SCHEME 4. CONCLUSION 2

3 1. INTRODUCTION 3

4 About Indonesia  World’s largest archipelago – 17,000 islands  World’s 4 th most populated nation million people, unevenly distributed  World’s largest Moslem population  Strong cultural and religious values

5 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$  37.5% from public spending, 61.4% from private spending  72% of population  now covered by insurance (various schemes),  28% of population  uninsured

6 Law No. 40/2004 The essence: To synchronize implementation of social security in Indonesia The purpose: To guarantee protection and social welfare for all people 6

7 Health Insurance Accident insurance Life insurance Public pension Old age pension 7

8 Add Your Text 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 8

9 2. EXISTING HEALTH INSURANCE IN INDONESIA 9

10 Some Short Comings in EXISTING 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

11 EXISTING HEALTH INSURANCE COVERAGE Coverage : June people covered (72 % of population) • JAMKESMAS: (36,3 %) • JAMKESDA: (16,79 %) • ASKES PNS: (06,69 %) • TNI/POLRI/PNS KEMHAN: (00,59 %) • JPK JAMSOSTEK: (02,96 %) • COMPANY SELF INSURANCE: (07,12 %) • COMMERCIAL INSURANCE: (01,2 %) 11

12 EXISTING HEALTH INSURANCE COVERAGE (JUNE 2013)

13 3. POLICY & DESIGN OF NATIONAL HEALTH INSURANCE (STARTING FROM 1 JANUARY 2014) 13

14 LEGAL FOUNDATION FOR INDONESIA’S NATIONAL HEALTH INSURANCE LEGAL FOUNDATION FOR INDONESIA’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 14

15 ROADMAP TO UHC 20%50%75%100% 20%50%75%100% 10%30%50%70%100% `Enterprises Big20%50%75%100% Middle20%50%75%100% Small10%30%50%70%100% Micro10%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 into BPJS Kesehatan and regulation of commercial insurance industry Integration of Jamkesda into 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 148,2mio 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 Activities: Transformation, Integration, Expansion BSKBSK 73,8 mio uninsured people Uninsured people 90,4 mio Presidential decree on operational support for Army/Police 86,4 mio PBI 15

16 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. 16

17 Premium of National Health Insurance MEMBERPREMIUMMonthly membership fee (IDR) REMARK SUBSIDIZED MEMBER NOMINAL (per member) ,-Class 3 IP care CIVIL SERVANT/ARMY/POL ICE/ 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 employee 4% from employer Class 1 & 2 IP care NON WAGE EARNERS/ INDEPENDENT MEMBERS NOMINAL (per member) 1. 25,500, ,500, ,500,- 1.Class 3 IP care 2.Class 2 IP care 3.Class 1 IP care 17

18 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 18

19 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 19

20 HEALTH CARE PROVIDERS AND PAYMENT METHODS 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

21 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

22 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 Regulation on Quality of care, HR, Pharmaceutical, etc Regulation on standardization of tariff Government Referral system MINISTER OF HEALTH 22

23 TASK FORCES: Preparing For National Health Insurance 1.Health facilities, referral system & infra-structure 2.Finance, transformation of program & institutions, as needed 3.Regulations 4.Human resources & capacity building 5.Pharmaceutical & medical devices 6.Socialization & advocacy 23

24 Preparations in line with roadmap/ action plan Task forceTasks 1. 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/ Dentist : 11/ Midwives : 75/ : 4/PHC Nurses : 158/ : 6/PHC Total hospital : hospitals Total bed : beds 24 1

25 Preparations in line with roadmap/ action plan Task forceTasks 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 2

26 Task ForceTasks 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 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 26 3 Preparations in line with roadmap/ action plan

27 Task ForceTasks 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 27 4 Preparations in line with roadmap/ action plan

28 HOW TO ENROLL? Registration: 1.BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices) 2.Online registration  3.Mobile customer services HOTLINE:

29 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 29

30  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 CONCLUSION

31 Thank You

32


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