moving towards universal health coverage in indonesia

Report
MINISTER OF HEALTH
REPUBLIC OF INDONESIA
MOVING TOWARDS
UNIVERSAL HEALTH ACCESS IN
INDONESIA
Dr. Nafsiah Mboi, Sp.A, MPH
Minister of Health
Republic of Indonesia
1
OUTLINE
1. INTRODUCTION
2. EXISTING HEALTH INSURANCE IN
INDONESIA
3. POLICY & DESIGN OF INDONESIA’S
NATIONAL HEALTH INSURANCE SCHEME
4. CONCLUSION
2
1. INTRODUCTION
3
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
Law
No. 40/2004
The essence:
The purpose:
To synchronize
implementation of social
security in Indonesia
To guarantee
protection and social
welfare for all people
6
1
2
Health Insurance
Accident insurance
3
Old age pension
4
Public pension
5
Life insurance
7
1
All employed citizens (in formal or informal sectors)
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who have income shall contribute to the program
2
Basic benefits guaranteed
3
Those who wish more protection, are freeAdd
to Your Text
purchase additional services on commercial basis
4
Planned, phased implementation
5
Government is regulator
Add Your Text
8
2. EXISTING HEALTH INSURANCE IN
INDONESIA
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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
EXISTING
HEALTH INSURANCE COVERAGE
Coverage : June 2013
176.844.161 people covered (72 % of population)
•
•
•
•
•
•
•
JAMKESMAS
: 86.400.000
JAMKESDA
: 45.595.520
ASKES PNS
: 16.548.283
TNI/POLRI/PNS KEMHAN : 1.412.647
JPK JAMSOSTEK
: 7.026.440
COMPANY SELF INSURANCE: 16.923.644
COMMERCIAL INSURANCE : 2.937.627
(36,3 %)
(16,79 %)
(06,69 %)
(00,59 %)
(02,96 %)
(07,12 %)
(01,2 %)
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EXISTING HEALTH INSURANCE COVERAGE
(JUNE 2013)
28
36.3
12
3. POLICY & DESIGN OF
NATIONAL HEALTH
INSURANCE
(STARTING FROM 1
JANUARY 2014)
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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
ROADMAP TO UHC
86,4 mio PBI
121,6 mio covered
by BPJS Keesehatan
Coverage of various existing
schemes 148,2mio
Uninsured people 90,4
mio
50,07 mio covered
by other schemes
73,8 mio uninsured
people
Activities:
Transformation, Integration, Expansion
`Enterprises
2014
2015 2016
Big
Middle
Small
Micro
20%
20%
10%
10%
50%
50%
30%
25%
Transformation from 4 existing schemes to
BPJS Kesehatan (JPK Jamsostek, Jamkesmas,
Askes PNS, TNI Polri )
Presidential decree
on operational
support for
Army/Police
Procedure
setting on
membership
and
contribution
2017
2018
75% 100%
75% 100%
50% 70% 100%
40% 60% 80%
2019
257,5 mio (all
Indonesian
people) covered
by BPJS
Kesehatan
Level of
satisfaction 85%
100%
Integration of Jamkesda into BPJS Kesehatan
and regulation of commercial insurance industry
Pengalihan
Kepesertaan
TNI/POLRI ke BPJS
Kesehatan
Company
mapping
and
socialization
Synchronization membership data:
JPK Jamsostek, Jamkesmas dan Askes
PNS/Sosial – single identity number
Membership expansion to big, middle, small and micro enterprises
B
S
K
20%
50%
75%
100%
20%
50%
75%
100%
10%
30%
50%
70%
100%
100%
Consumer satisfaction measurement every 6 month
Benefit package and sevices review annually
15
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)
NOMINAL
(per member)
19.225,-
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
Until 30 June 2015:
0,5% from employee
4% from employer
Class 1 & 2 IP care
5% (per household)
Start from 1 July2015:
1% from employee
4% from employer
NOMINAL
(per member)
1. 25,500,2. 42,500,3. 59,500,-
SUBSIDIZED
MEMBER
NON WAGE
EARNERS/
INDEPENDENT
MEMBERS
REMARK
Class 3 IP care
1. Class 3 IP care
2. Class 2 IP care
3. Class 1 IP care
17
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
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
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: InaCBG’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
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NATIONAL HEALTH INSURANCE
MINISTER OF HEALTH
Government
BPJS
Kesehatan
Regulation on delivery
of health services
Regulation on Quality of
care, HR,
Pharmaceutical, etc
Regulator
Regulation on
standardization of tariff
Delivery of service
Members
utilization of service
Healthcare
providers
Referral system
22
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
Preparations
in line with roadmap/ action plan
Task force
1. Health facilities,
referral system,
and infrastructure
1
Tasks
 Preparation of health care providers
 Strengthening of referral system by

regionalization
Procurement of medical devices
Ratio:
Medical doctor
Dentist
Midwives
Nurses
: 40/100.000
: 11/100.000
: 75/100.000: 4/PHC
: 158/100.000: 6/PHC
Total hospital
Total bed
: 2.138 hospitals
: 264.303 beds
24
Preparations
in line with roadmap/ action plan
Task force
2. Finance,
transformation of
programs and
institutions, as
needed
2
Tasks
 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
Preparations
in line with roadmap/ action plan
Task Force
3. Regulation –
regulatory
infrastructure to
support implementation
•
•
•
•
3
Tasks
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
• Developing HR mapping, distribution, and
resources and
assignment
capacity building • Design and carrying out training, as needed
26
Preparations
in line with roadmap/ action plan
Task Force
4
Tasks
5.Pharmaceutical • Setting formularies for drugs and
and medical
medical devices
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
HOW TO ENROLL?
Registration:
1. BPJS Kesehatan Offices (Headquarter, Regional
and Branch Offices)
2. Online registration  www.bpjs-kesehatan.go.id
3. Mobile customer services
HOTLINE: 500400
28
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
CONCLUSION
 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
Thank You

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