Presentation on theme: "MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA"— Presentation transcript:
1 MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA MINISTER OF HEALTHREPUBLIC OF INDONESIAMOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIALadies and gentlemen,It is a pleasure and an honor to be with you today for this discussion of one of the great issues of public policy that Indonesia will undertake starting in We will launch our system of universal health coverage with implementation of the first phase of our new National Social Health Insurance scheme.Dr. Nafsiah Mboi, Sp.A, MPHMinister of HealthRepublic of Indonesia1
2 OUTLINE 1. INTRODUCTION 2. EXISTING HEALTH INSURANCE IN INDONESIA 3. POLICY & DESIGN OF INDONESIA’S NATIONAL HEALTH INSURANCE SCHEMEThe outline for my today’s presentation is as follows :IntroductionExisting Health Insurance Program in IndonesiaPolicy and Design of the National Health Insurance SchemeConclusion4. CONCLUSION2
3 1. INTRODUCTIONA brief comment on the pictures running through this presentation. There is no special connection between the pictures and text but the pictures are to remind us that the purpose of all of our efforts to to give a better life to more Indonesians wherever we find them.We talk here about policy and systems but the point is to serve PEOPLE!
4 World’s largest archipelago – 17,000 islands About Indonesia World’s largest archipelago – 17,000 islands World’s 4th most populated nation million people, unevenly distributedWorld’s largest Moslem populationStrong cultural and religious valuesA quick review for old timers. A brief introduction for new comers
5 INDONESIAN HEALTH FINANCING 2011 GDP per capita US$ 3,494Total Health Expenditure Rp 214,9 Trillion, 2.9% of GDPPer capita Health Expenditure US$37.5% from public spending,61.4% from private spending72% of population now covered by insurance (various schemes),28% of population uninsuredWe see here Indonesian health financing figures from the year At that time the situation was as follows :GDP per capita US$ 3,494Total Health Expenditure 214,9 Trillion IDR, it is 2.9% of GDPPer capita health expenditure US$ 101,137.5% from public spending, 61.4% from private spending72% of population already covered by insurance (various schemes), 28% of population is still uninsured
6 National Social Security System LawNo. 40/2004The essence:To synchronize implementation of social security in IndonesiaThe purpose:To guarantee protection and social welfare for all peopleThe law No 40/2004 on National Social Security System was promulgated in 2004.The law clarified and synchronized Indonesia’s approach to social security in Indonesia with the purpose of guaranteeing protection and social welfare for all Indonesians.
7 Components of Social Security system 1Health Insurance2Accident insurance3Old age pension4The National Social Security System includes 5 components :Health InsuranceWork Accident InsuranceOld age pensionPublic pensionLife InsuranceToday we are talking about the up-coming launch of health insurance.Public pension5Life insurance
8 Social Security Concept 1All employed citizens (in formal or informal sectors) who have income shall contribute to the programAdd Your Text2Basic benefits guaranteedAdd Your Text3Those who wish more protection, are free to purchase additional services on commercial basisAdd Your Text4Slide – self explanatory.Planned, phased implementation5Government is regulator
9 2. EXISTING HEALTH INSURANCE IN INDONESIA Before I talk about preparation for and launch of the new system let me give a bit of information about the situation as of now.
10 Some Short Comings in EXISTING HEALTH INSURANCE SCHEMES Lack of integration in implementation and coverage.Fragmented fund-pooling & managementDifferent benefit packages and limits among schemesVariations in management systems of different providersLimited and uneven monitoring, evaluation and coordination among schemesWhile public and private insurance have been growing since independence we find various short comings in the current situation. These work to the disadvantage of the public. The national system to be launched intends to overcome such problems.
11 EXISTING HEALTH INSURANCE COVERAGE Coverage : June 2013people 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 %)Content the same as previous slides but shows numbers of people covered under each pgm. :Coverage : as of June 2013(72 % of population)JAMKESMAS : (36,3 %)JAMKESDA : (16,79 %)COMPANY SELF INSURANCE : (07,12 %)ASKES PNS : (06,69 %)JPK JAMSOSTEK : (02,96 %)COMMERCIAL INSURANCE : (01,2 %)TNI/POLRI/PNS KEMHAN : (00,59 %)
12 EXISTING HEALTH INSURANCE COVERAGE (JUNE 2013)2836.3This slide shows the patch work of existing public and private health insurance pgms and the % of the population covered by each.The biggest one is Jamkesmas covering 36.3% of the population NM – suggest adding comment on who is covered by JamKesMas.The second one is Jamkesda covers 16.79% of the population, the third one is self insured population covered by companies, followed by Askes (civil servants), JPK Jamsostek, Commercial Insurance, and Armed Forces and Police.Overall, a total of 72% of the population are already covered by insurance, leaving 28% of population with no coverage.
13 3. POLICY & DESIGN OF NATIONAL HEALTH INSURANCE (STARTING FROM 1 JANUARY 2014) I will now give you some basic information about practical policy and operations of the new system.
14 INDONESIA’S NATIONAL HEALTH INSURANCE LEGAL FOUNDATION FORINDONESIA’S NATIONAL HEALTH INSURANCEConstitution of 1945Act 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 InsuranceOther regulationsThe National Social Health Insurance program has a robust legal basis. As of today most of legal infrastructure is already in place :Constitution 1945Act No 40/2004 on National Social Security System (SJSN)Act No 24/2011 on Social Security Agency (BPJS)Governmental Decree No 101/2012 on Beneficiaries Govt Subsidy (PBI)Presidential Decree No 12/2013 on Social Health Insurance (JKN)
15 ROADMAP TO UHC20122013201420152016201720182019Transformation 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 contributionCompany mapping and socializationConsumer satisfaction measurement every 6 monthIntegration of Jamkesda into BPJS Kesehatanand regulation of commercial insurance industryPengalihan Kepesertaan TNI/POLRI ke BPJS KesehatanBenefit package and sevices review annuallySynchronization membership data: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single identity numberCoverage of various existing schemes 148,2mio121,6 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, ExpansionBSK73,8 mio uninsured peopleUninsured people 90,4 mioPresidential decree on operational support for Army/Police86,4 mio PBI`Enterprises201420152016201720182019Big20%50%75%100%MiddleSmall10%30%70%Micro25%40%60%80%This is the roadmap which is taking us from launching of the system in 2014 to full achievement of UHC by This is probably more detail than we need here today but examining the roadmap we see that some activities are part of the on-going scheme from year one – for example from the beginning consumer satisfaction is to be measured every 6 months and benefit packages will be reviewed annually to be sure service is both effective and patient friendly.Coverage, is expanded year by year toward the goal of complete coverage in 2019.20%50%75%100%10%30%70%15
16 MEMBERSHIP Members All people who have paid premium or for whom it has been paidTwo categories of members:a. People with incomes below the stipulated poverty line premium paid by governmentb. All others pay the premium - workers in formal sector, independent members, including foreigners who work in Indonesia for 6 months or longer.The Indonesian National Social Health Insurance is a compulsory health insurance scheme in which everyone must enroll.MEMBERS : Everyone has paid their own contribution or for whom it has been paid2 Categories of Members :a. Subsidized members : people with incomes below the stipulated poverty levelb. All others who have paid contribution -- workers from formal and informal sector -- including foreigners who work in Indonesia at least 6 months.
17 Premium of National Health Insurance MEMBERPREMIUMMonthly membership fee (IDR)REMARKSUBSIDIZED MEMBERNOMINAL(per member)19.225,-Class 3 IP careCIVIL SERVANT/ARMY/POLICE/ RETIRED5%(per household )2% from employee3% from employerClass 1 & 2 IP careOTHER WORKERS WHO RECEIVE MONTHLY SALARY/WAGE4,5 %(per household)And5% (per household)Until 30 June 2015:0,5% from employee4% from employerStart from 1 July2015:1% from employeeNON WAGE EARNERS/ INDEPENDENT MEMBERS1. 25,500,-2. 42,500,-3. 59,500,-Class 2 IP careClass 1 IP careThe premium of National Health Insurance that will be implemented next year:SUBSIDIZED MEMBER (PBI) : Rp ,- per member per month, in patient benefit in ward class 3CIVIL SERVANT/ARMY/POLICE/RETIRED : 5% of salary per household per month, which comes from 2% employee contribution and 3% employer contributionOTHER WORKERS WHO RECEIVE MONTHLY SALARY/WAGE: 4,5% of salary/wage per household per month, which comes from 0,5% employee contribution and 4% employer contribution starting from January 2014 until June And 5% of salary/wage per household per month starting from July 2015, which comes from 1% employee contribution and 4% employer contribution.FOR WORKERS WHO DO NOT RECEIVE MONTHLY SALARY/WAGE: there are 3 choices, the first one is Rp per member per month for in patient benefit in ward class 3, the second one is Rp per member per month for in patient benefit in ward class 2 and the third one is Rp per member per month for in patient benefit in ward class 1.
18 BENEFIT PACKAGESBenefit package : personal health care covering promotive, preventive, curative & rehabilitative servicesBenefit package : includes both medical & non medical, such as hosp accommodation, ambulance etcRegulation stipulates services coveredThe Benefit Package under the scheme will be clearly defined and includes full spectrum of health concerns.The Benefit Package is focused on personal health care and covers promotive, preventive, curative and rehabilitative health servicesThe benefit package includes both medical and non medical services, for example, accommodation and ambulanceRegulations will stipulate services covered
19 FINANCE: CONTRIBUTION (PREMIUM) Contribution for people below the poverty line (PBI)→ paid by central (and local) governmentContributions of members paying their own premiumWorkers 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 schemePayment of the individual contributions is an essential component in the design and management of the overall Social Health Insurance system. We have given great care, therefore, to achieve fair and accurate calculations for contributions. Funding for the scheme is made up as follows :Pooling of funds from contributions of individual membersSubsidized Contribution for those below the poverty line (PBI) from central and/or local governmentStructuring the contribution of individual members :Workers in the formal sector : contribution is made up by employer and employee calculated as percentage of salary/ wage.Workers in the informal sector : a stipulated amount of money
20 HEALTH CARE PROVIDERS AND PAYMENT METHODSHealthcare providersPrimary health care providers: Public Health Service, Private clinics, Primary Care DoctorsSecondary & tertiary health care providers: Hospitals both public hospitals and private hospitalsPayment methodsPrimary health care providers: capitation & noncapitationSecondary and tertiary health care providers: Ina-CBG’s (Case-based Group)Health care providers and payment methods:Healthcare providersPrimary health care providers: Public Health Service, Private clinic, Private DoctorSecondary and tertiary health care providers: Hospitals both public hospitals and private hospitalsPayment methodsPrimary health care providers: capitationSecondary and tertiary health care providers: Ina-CBG’s (Indonesian - Case Based Groups)
21 ADMINISTRATION & MANAGEMENT Administered 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, etcAdministration and management of National Health InsuranceAdministered by BPJS Kesehatan (single payer)BPJS Kesehatan managing members, healthcare providers, providers claim, member complain, etcGovernment (MoH, MoF, DJSN): monitors andevaluate implementation of National Health Insurance schemeMoH regulates delivery of health services, drug and medical devices, tariff, etc
22 NATIONAL HEALTH INSURANCE MINISTER OF HEALTHNATIONAL HEALTH INSURANCERegulatorBPJS KesehatanMembersHealthcare providersContributionComplain managementContractClaimsPaymentutilization of serviceDelivery of serviceRegulation on delivery of health servicesRegulation on Quality of care, HR, Pharmaceutical, etcRegulation on standardization of tariffGovernmentReferral systemThe mechanism which will come into effect from 2014 onward involves the following players with specific roles for each :The Government, specifically MoH : sets regulations for standardization delivery of health services, tariff, drugs, and medical devices, etcBPJS Kesehatan : administers the health insurance scheme including collection of contributions, complaints management, contract arrangements, claim payments, etcHealth Care Providers (public and private): provide health servicesMembers of the public : pay contribution and utilize available services22
23 TASK FORCES: Preparing For National Health Insurance Health facilities, referral system & infra-structureFinance, transformation of program & institutions, as neededRegulationsHuman resources & capacity buildingPharmaceutical & medical devicesSocialization & advocacyBuilding this systems for our large population, spread unevenly across our large nation has been a challenge task forces have worked on different aspects of the system. I include this not for all the details but to give you a sense of the many issues involved.Health facilities, referral system, and infrastructureFinance and transformation of program and institution, as neededRegulationHuman resources and capacity buildingPharmaceuticals and medical devicesSocialization and advocacy
24 Preparations in line with roadmap/ action plan 1Task forceTasks1. Health facilities, referral system, and infrastructurePreparation of health care providersStrengthening of referral system by regionalizationProcurement of medical devicesRatio:Medical doctor : 40/Dentist : 11/Midwives : 75/ : 4/PHCNurses : 158/ : 6/PHCTotal hospital : hospitalsTotal bed : bedsLauncing this scheme is a technical, managerial, and financial challenge. Let me tell you a bit about the activity of the various working groups.Health facilities, referral system, infrastructure task force is doing on:Preparing health care providersRevitalization referral system by strengthening regionalizationProcuring medical devicesFinance and transformation of programs and institutions, as needed:Setting contributions and tariffsPreparing transformation of existing insurance programs: Jamkesmas, Askes PNS, Army/Police dan JPK JamsostekPreparing transformation from PT Askes to BPJS Kesehatan for management
25 Preparations in line with roadmap/ action plan 2Task forceTasks2. Finance, transformation of programs and institutions, as neededSetting premiums and tariffsPreparing transformation of existing insurance & programs : Jamkesmas, Askes PNS, TNI Polri & JPK Jamsostek to Nat Soc Health InsPreparing transformation/ migration of management PT Askes → BPJS KesehatanLauncing this scheme is a technical, managerial, and financial challenge. Let me tell you a bit about the activity of the various working groups.Health facilities, referral system, infrastructure task force is doing on:Preparing health care providersRevitalization referral system by strengthening regionalizationProcuring medical devicesFinance and transformation of programs and institutions, as needed:Setting contributions and tariffsPreparing transformation of existing insurance programs: Jamkesmas, Askes PNS, Army/Police dan JPK JamsostekPreparing transformation from PT Askes to BPJS Kesehatan for management
26 Preparations in line with roadmap/ action plan 3Task ForceTasks3. Regulation – regulatory infrastructure to support imple-mentationDev 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 Scheme4. Human resources and capacity buildingDeveloping HR mapping, distribution, and assignmentDesign and carrying out training, as needed3. Regulation task force :Arranging and passing Governmental Decree No 101/2012 on Beneficiaries of Govt subsidy (PBI) and Presidential Decree No 12/2013 on Social Health Insurance (SJSK).Preparing other Governmental Decrees and Presidential Decrees related to National Health Insurance schemePreparing MoH decree the management of the scheme)4. Human Resource and capacity building task force :Mapping of existing human resources and needs of the new national health insurance system, structuring and and assigning staff as neededDesigning and carrying out staff training
27 Preparations in line with roadmap/ action plan 4Preparations in line with roadmap/ action planTask ForceTasks5.Pharmaceutical and medical devicesSetting formularies for drugs and medical devicesDeveloping e-catalogueForming Health Technology Assessment (HTA) team and their tasks6. Socialization and advocacyPreparing strategy, materials ,and media for socialization of the new National Social Health Insurance schemeConducting intensive and wide-reaching socialization and advocacyPharmaceutical and medical devices task force :Setting drug and medical devices formularyPreparing e-catalogueForming Health Technology Assessment (HTA) team and their tasksSocialization and advocacy task force :Preparing strategy, materials, and media to explain and socialize the new National Health Insurance schemeConducting intensive and wide-reaching socialization, advocacy
28 HOW TO ENROLL? Registration: BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices)Online registration Mobile customer servicesHOTLINE:How to enroll the National Health Insurance? There are 3 ways:Register at BPJS Kesehatan Offices (headquarter, regional, branch offices)Online registration through website:Register at mobile customer servicesBPJS Kesehatan Hotline :
29 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 HeadPayment of the individual contributions is an essential component in the design and management of the overall Social Health Insurance system. We have given great care, therefore, to achieve fair and accurate calculations for contributions. Funding for the scheme is made up as follows :Pooling of funds from contributions of individual membersSubsidized Contribution for those below the poverty line (PBI) from central and/or local governmentStructuring the contribution of individual members :Workers in the formal sector : contribution is made up by employer and employee calculated as percentage of salary/ wage.Workers in the informal sector : a stipulated amount of money
30 CONCLUSIONIndonesia’s National Social Health Insurance wil be launched on 1 Jan 2014 → legal basis from Constitution of 1945 to new regulations and decrees, as neededCoverage of National Health Insurance will expand gradually → Universal Coverage in 2019Implementation of National Health Insurance calls for reforms, in both delivery of health services and health financing. Preparation well advanced for 1 January 2014 launch