Strengthening ,QGRQHVLD·V Health System through the National … Prof. DR. Dr. Fachmi Idris... · Web-based application BPJS Kesehatan 1. Healthcare facilities location 2. Healthcare

Prof. Dr. dr. Fachmi Idris, MKes

President Director

1st Sriwijaya University International Conference on Public Health:

Public Health Responses to Health Systems Strengthening

Palembang, 5 Oktober 2017

Strengthening Indonesia’s

Health System through the

National Health Security

1

www.bpjs-kesehatan.go.id 021 –1 500 400

http://www.bpjs-kesehatan.go.id/



I. INTRODUCTION

II. STRENGTHENING HEALTH SYSTEM THROUGH THE

IMPLEMENTATION OF NATIONAL HEALTH INSURANCE

III. CHALLENGES

Topics

INTRODUCTION

HEALTH SYSTEM

World Health Report 2000:

Health System (Gro Harlem Burtland)

Leadership/Governance

Health Care Financing

Health Workforce

Medical Products, Technologies

Information Research

Service Delivery

System Building Blocks (6 blocks)

Presidential Decree 72/2012:

National Health System

Research and Development on

Health

Health Financing

Health Workforce

Pharmaceutical, medical devices and food supply

Management, Information and Regulation on Health

Community Empowerment

Subsystems of National Health System (7 blocks)

Health Effort on Personal and

Community

4





HEALTH SYSTEMS PERFORMANCE

FRAMEWORK (WHO 2000)

Stewardship

Financing

Creating Resources

(Investment &

Training)

Delivering

Services

Responsiveness

people’s expectation)

Fair Financial

Contribution

Health

(collecting,

Pooling and

Purchasing) – 6

sub systems of

financing

National Health Insurance

5





3,5 Years of

JKN-KIS

2014 - June 2017

Health Financing

Pharmaceutical Medical

Devices and Food Supply

Health Workforce

Community Empowerment

Information management Regulation on Health

Research and Development

Health Effort on Personal

and Community

National Health System

Presidential Decree No 72/2012

Sustainibility :

• Affordability

• Acceptability

• Adaptability

Strengthening

Sustainability

Stimulating

Success

Success* :

• Healthy community

• Superior healthcare

• Fairness

*Fineberg V. F. (2012)





The progress towards universal

health coverage

0

20

40

60

80

100

120

140

127 yrs

118 yrs

79 yrs 72 yrs

48 yrs

36 yrs

26 yrs 8

5%

Po

p (

80

,6 m

ill.

)

10

0 %

Po

p (

11

,4 m

ill.

)

99

% P

op

(8,7

mil

l.)

10

0 %

Po

p

(58

2,2

91

)

87

% P

op

(4,8

Jt )

10

0 %

Po

p

(12

6,7

Jt )

97

,2 %

Po

p

(50

,9 J

t )

Germany Belgium Austria Luxemburg Costa Rica Japan South Korea

UHC: International comparison 3,5 years

towards

UHC

2014-

2019

2016

133.423.653

156.790.287

180.498.482

171.939.254

1st semester

(18 August 2017)

> 70% of

the population

2014 2015

Source: LPP Jamsoskes

7





JKN’s effect on National Health System

• Health

– Life expectancy rate in Indonesia is increasing (OECD 2016)

• Responsiveness

– JKN is effective in improving health equity for poor and near poor community (PRAKARSA, 2017)

– Costumer satisfaction index of JKN Participants is 78,6% (BPJS Kesehatan, 2017)

• Fair Financial Contribution

– With the new JKN scheme, the level of OOP spending among the insured population is decreasing (WHO, 2017)

8





STRENGTHENING HEALTH SYSTEM THROUGH

THE IMPLEMENTATION OF NATIONAL HEALTH

INSURANCE

10

Key Function of Health Care System

Tertiary Hospital

Secondary Hospital

Primary Care with

Inpatient

Gatekeeper Primary

Care

Individual/

family

1. Arrangement of provider distribution

capacity planning 2. Gatekeeper

3. Healthcare Standard (human

resource,

facilities, guidelines)

4. Regulation

5. Reverse referral system (referral

from secondary to primary care for

chronic disease patients in stable

condition)

6. Sufficient incentives

7. Continuous, accurate and real

time information system

8. Standardized administration

9. Emergency management

service 10. Monitoring and evaluating

11. Continuous communication with

healthcare providers and

beneficiaries

021 –1 500 400 www.bpjs-kesehatan.go.id

Source: Adapted from Ministry of Health Decree No. 01/2012

and 71/2013 By Deputy of Primary Financing Insurance




Health care benefit

Focus on individual health rather than public health Health promotion, disease prevention, curative, rehabilitative, drug &

medical devices based on medical indication using referral system

Medical

Non medical

Primary care

Ambulance

Inpatient accommodation

Supplement (spectacles)

Promotive & preventive: 1.Individual health counseling 2.Screening (diabetes, hypertension,

cervical cancer) 3.Immunization (basic and advance) 4.Family planning

Curative & rehabilitative 1. Outpatient 2. Inpatient 3. Obstetric 4. Emergency care

Vaccine, contraception provided by government

Secondary care

11

12

2014 Audited Report by Dec

2015 Audited Report by Dec

66,8

million

21,3

million

PHC

Outpatient

Inpatient

4,2

million

100,6

million

39,8

million

6,3

million

133,4

million

Total Cost: 42 T Total Cost: 57 T Total Cost: 69 T

156,79

million 2016 Audited Report by Dec

171,9

million

134,9

million

50,4

million

7,6

million

Healthcare Utilization 2014-2016 Improving Access and Degree of Health

PHC

Outpatient

Inpatient

PHC

Outpatient

Inpatient





13

2017 1st Semester

Health Utilization and Catastrophic Care per 1st Semester 2017

72,8

million

29,2

million

4,02

million

178,3

million

Data source : LPP Jamsoskes

DIRECT CONTRIBUTION: Enhance health recovery and prevent

disablement through health promotion and disease prevention

source : Data BOA, per June 2017 (loading month)

Protect community

from poverty and

the poor from

catastrophic health

expenditure Improve the productivity of the community

both socially & economically

PHC

Outpatient

Inpatient

2014 2015 2016

Cost of catastrophic diseases*

* Cardiovascular, cancer, kidney failure, stroke, thalassemia, cirrhosis Hepatic, leukaemia, haemophilia

** Percentage from total hospital costs

• 7 million cases

• 10,6 trillion

IDR

37,32 %**

• 10,3 million cases

• 13,9 trillion

IDR

32,41 %**

• 9,8 million cases

• 12,7 trilllion

IDR

24,81 %**





Healthcare Facilities: more than 50% private

hospitals accepted referrals

78,8%*

Data source : LPP Jamsoskes *of registered hospital

14





Healthcare Cost 2014-2016

168 T Primary and Secondary

Repeated outpatient increasing (Q-5-44-0)

• 19.7 mil cases (2014) → 34.4 mil

cases (2016)

• Cost: 3.7 T 4 →6. T (2016)

Triple Burden Of Diseases

• Infectious Diseases

• Chronic Diseases

• Mental Disease

Healthcare Cost





21,62% 20,34% 19,65%

78,38% 79,66% 80,35%

10%

0%

20%

70%

60%

50%

40%

30%

80%

90%

Trend of Healthcare Cost Ratio 2014-2016

Secondary care

Primary care

2014 2015 2016

There is a decreasing trend of cost ratio for primary care compared to secondary care from

2014 to 2016





Access to high quality

PHC

Optimum Reverse Referral System

Peer Review Per

PHC

Health promotion & disease

prevention

Pay for Performance

& Walk Through

Audit

Strengthening Primary care function

• Credentialing/

Recredentialing

• Support from

related parties

• Simple

administration

• Sufficient drug

supplies

• Presence of

pharmacy

• Therapy

Management

• CME

• Planning

• Outonomy (BLUD)

• PROLANIS

revitalisation &

development

• Early detection

• Monev

• Implementation

Research

• Campaign

• Monitoring and

Evaluating





Health promotion & disease prevention strategy

Prevent

complication

Disease

management

BPJS members

Healthy Risky Sick

Prevent from

being sick

Maintain/

promote

Health promotion & disease prevention programs

Good quality of life

Sustained JKN

Important role of primary care doctors in implementing health

promotion & disease prevention programs 18

19

CHALLENGES

Challanges

Healthcare facilities

supply 1

Cost containment 2

Referral system 3

Need improved understanding about INA

CBGs payment system

• The growth of healthcare facilities is lower

than the growth of participants

• Uneven healthcare facilities distribution

Most people are specialist and hospital-

minded, reluctant to visit primary care

facilities as their first contact





Challenges (2)

Adverse Selection 4

The behavior where

people seek health

insurance when they

need healthcare





EFFORTS TO IMPROVE NATIONAL HEALTH SECURITY

BPJS Kesehatan Care Center 1500-400

1. Information

2. Complaint handling

3. Teleconsulting

Web-based application BPJS

Kesehatan

1. Healthcare facilities location

2. Healthcare facilities registered as BPJS

Kesehatan provider

3. Real-time online referral system to

hospitals

Improving Services

1. Bridge Information System between

healthcare facilities and BPJS Kesehatan

2. Developing Coordination of Benefit (COB)

3. No cost sharing

4. Reverse referral system optimization

5. Health promotion & disease prevention

programs:

- Prolanis

- IVA Papsmear

- Health screening through Mobile JKN

- Exercises

6. HFIS application to simplify provider

registration process

Mobile JKN Virtual Office

1. Registration

2. Contribution payment status

3. Medical history check

4. Healthcare facilities location

5. Change participant data

Ease of registration access

1. Drop Box system in BPJS branch office

2. Registration in banks and malls

3. Mobile JKN and BPJS Kesehatan

website

4. BPJS Kesehatan Care Center 1 500 400

5. Mobile Customer Service

6. Drop Box on sub district office

7. BPTSP (one-roof registration)

8. Kader JKN (door-to-door agents)

9. E-Dabu (web-based registration for

business entities)

Ease of payment access

1. ATM

2. Traditional and modern PPOB

(minimarket, online shop)

3. SMS Banking, Internet Banking

4. PT. POS Indonesia





CONCLUSION

The JKN program is one of the government's efforts to strengthen the health system in Indonesia. For 3.5 years BPJS Health operates, has reached more than 180 million people so that they are protected both access and financial.

Many things that must be done to maintain the continuity of this program, ranging from revisions of laws and regulations that can synergize positively to build programs, alternative sources of financing and benefit packages. Support from various parties is also needed, one of them is related to the distribution of health facilities to improve access.









Documents

Strengthening ,QGRQHVLD·V Health System through the National … Prof. DR. Dr. Fachmi Idris... · Web-based application BPJS Kesehatan 1. Healthcare facilities location 2. Healthcare