MOVING TOWARDS UNIVERSAL HEALTH

COVERAGE IN INDONESIA

11th ASEAN and Japan HLOM on Caring Societies

Panel Discussion:

Universal Health Coverage as a basis for ‘Active Aging’ and Medical and Welfare

Services, Health Promotion, and Disease Prevention

Number of Island: 17,504 Population, 2012 ± 246,9 millionGDP per Capita 2012 (in USD): 3,592 Decentralized Government: 34 provinces; 508 districtsLife Expectancy Life Expectancy 70,970,9 years years (2010)(2010) Number of population 60+ years in Indonesia will increase from 18.1 million in 2010 to 29.1 million in 2020 or approximately 11.4% of the total population and 36 million in 2025. Now number of the elderly has reached about 23 million.

INDONESIA

CURRENT HEALTH INSURANCE COVERAGE BY

2013

EXISTING HEALTH INSURANCE PROGRAM IN INDONESIA

1. Disintegrated implementation and coverage

2. Fragmented fund pooling & management

3. Limited & variations of benefit among schemes

4. Variations of carriers management

5. Lack of monitoring, evaluation and coordination among schemes

POLICY FRAMEWORK AND EXPERIENCE ON INCREASING ACCESS TO HEALTH SERVICES FOR INDONESIAN

5

• Constitution• Act No 40/2004• Act No 24/2011• Govt decree No 101/2012• Presidential decree No 12/2013, others

-External factors- Internal factors

Existing Situation:1.Disintegrated implementation and coverage2.Fragmented fund pooling & management3.Limited & variations of benefit among schemes4.Variations of carriers management 5.Lack of monitoring, evaluation and coordination among schemes

Strategy:1. Synchronisation &

integration of schemes

2. Improve fund pooling

3. Optimising benefit package among schemes

4. Development of single carriers

5. Strengthen coordination, monitoring & evaluation

Efforts:

6 task forces:1. Regulation

2. Financing and Program transformation

3. Health Facilities, Referral System & Infrastructure

4. HR of health

5. Pharmaceutical and medical devices

6. Socialization

ExistingHealth

InsuranceCoverage

Universal Health

Coverage

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%

Transformation from 4 existing schemes to BPJS Kesehatan

(employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme)

Transformation from 4 existing schemes to BPJS Kesehatan

(employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme)

Membership expansion to big, middle, small and micro enterprises

Membership expansion to big, middle, small and micro enterprises

Procedure setting

on membership and contribut

ion

Procedure setting

on membership and contribut

ion

Company mapping

and socializat

ion

Company mapping

and socializat

ion

Consumer satisfaction measurement every 6 month

Consumer satisfaction measurement every 6 month

Integration of Jamkesda into BPJS Kesehatanand regulation of commercial insurance industry

Integration of Jamkesda into BPJS Kesehatanand regulation of commercial insurance industry

membership transfer of

army/police scheme to BPJS

Kesehatan

membership transfer of

army/police scheme to BPJS

Kesehatan

Benefit package and sevices review annually Benefit package and sevices review annually

Synchronization membership data: JPK

Jamsostek, Jamkesmas dan Askes PNS/Sosial – single

identity number

Synchronization membership data: JPK

Jamsostek, Jamkesmas dan Askes PNS/Sosial – single

identity number

Coverage of various existing schemes

148,2 mio

Coverage of various existing schemes

148,2 mio

111,6 mio covered by

BPJS Keesehatan

111,6 mio covered by

BPJS Keesehatan60,07 mio covered by

other schemes

60,07 mio covered by

other schemes

257,5 mio (all

Indonesian people)

covered by BPJS

Kesehatan

257,5 mio (all

Indonesian people)

covered by BPJS

KesehatanLevel of satisfaction

85%

Level of satisfaction

85%

Activities: Transformation, Integration,

Expansion

Activities: Transformation, Integration,

Expansion

BMS

73,8 mio uninsured

people

73,8 mio uninsured

people

Uninsured people 90,4 mio

Uninsured people 90,4 mio

Presidential decree on

operational support for Army/Police

Presidential decree on

operational support for Army/Police

86,4 mio PBI

86,4 mio PBI

6

BENEFIT PACKAGE

• Personal health care covering promotive, preventive, curative & rehabilitative services.

• The benefit incudes both medical and non medical concerns such as hospital accommodation, ambulance, etc

• Regulation stipulates services covered

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EXCLUSIONS (1)

• Health care without going through the procedures

• Health services in health facilities that is not contracted with BPJS

• Health services which is covered by covered by occupational accident insurance

• Health services abroad• Health services for aesthethic purposes• Health services for infertility (to have

children)• Orthodontic• Health disorders/diseases caused by drugs

addictions

8

EXCLUSIONS (2)

• Health problems related caused by activity endager himself

• Complementary treatment , alternative and traditional medication , including accupaucture, shin she, chiropractic and others that have not been declared by HTA

• Experimental medical treatment• Contraseptives, cosmetics, baby foods and milk• Health equipment for household• Health services for disaster situation• Another services which is not associated with

health insurance benefits 9

ADMINISTRATION AND MANAGEMENT

• Administered by BPJS Kesehatan (single payer)

• BPJS Kesehatan: managing members, healthcare providers, claims, complaints, etc

• Government: (MoH, MoF, DJSN) monitor and evaluate implementation

• MoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc

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JAMKESMAS EXPERIENCE FOR ELDERLY MEMBERSHIP

PROPOSED RECOMMENDATION

Increase an ability to provide our citizens with quality health care through systems that are sustainable and responsive to the health problems and health care demands, including an increasing number of elderly.

Committed to provide our community with access to comprehensive and quality universal health coverage (UHC) as an investment in future socio-economic well-being. Promote regional activities on sharing information and best practices in reducing the burden of disease and cost of care as well as in focusing health promotion and disease prevention to respond an increasing trends of non-communicable disease as populations’ age and life styles change.