MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN

INDONESIA

Dr. Nafsiah Mboi, Sp.A, MPHMinister of Health

Republic of Indonesia

MINISTER OF HEALTH REPUBLIC OF INDONESIA

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OUTLINE1. INTRODUCTION

2. EXISTING HEALTH INSURANCE IN INDONESIA

3. POLICY & DESIGN OF INDONESIA’S NATIONAL HEALTH INSURANCE SCHEME

4. CONCLUSION

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1. INTRODUCTION

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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

NATIONAL SOCIAL SECURITY SYSTEM

LawNo. 40/2004

The essence:To synchronize implementation of social security in Indonesia

The purpose:To guarantee protection and social welfare for all people

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COMPONENTS OF SOCIAL SECURITY SYSTEM

Health Insurance

Accident insurance

Life insurance

Public pension

Old age pension

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SOCIAL SECURITY CONCEPT

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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

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2. EXISTING HEALTH INSURANCE IN INDONESIA

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Some Short Comings inEXISTING 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 2013176.844.161 people covered (72 % of population)

• JAMKESMAS : 86.400.000 (36,3 %)• JAMKESDA : 45.595.520 (16,79 %)• ASKES PNS : 16.548.283 (06,69 %)• TNI/POLRI/PNS KEMHAN : 1.412.647 (00,59 %)• JPK JAMSOSTEK : 7.026.440 (02,96 %)• COMPANY SELF INSURANCE : 16.923.644 (07,12 %)• COMMERCIAL INSURANCE : 2.937.627 (01,2 %)

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EXISTING HEALTH INSURANCE COVERAGE(JUNE 2013)

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36.328

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

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LEGAL FOUNDATION FORINDONESIA’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

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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%

2012 2013 2014 2015 2016 2017 2018 2019

Transformation 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

contribution

Company mapping

and socialization

Consumer satisfaction measurement every 6 month

Integration of Jamkesda into BPJS Kesehatanand 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

BSK

73,8 mio uninsured people

Uninsured people 90,4 mio

Presidential decree on operational support

for Army/Police

86,4 mio PBI

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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)

REMARK

SUBSIDIZED MEMBER

NOMINAL (per member)

19.225,- Class 3 IP care

CIVIL SERVANT/ARMY/POLICE/ 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 employee4% from employer

Class 1 & 2 IP care

NON WAGE EARNERS/ INDEPENDENT MEMBERS

NOMINAL (per member)

1. 25,500,- 2. 42,500,-

3. 59,500,-

1. Class 3 IP care2. Class 2 IP care3. Class 1 IP care

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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

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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

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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

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

NATIONAL HEALTH INSURANCE

Regulator

BPJS Kesehatan

Members Healthcare providers

Contr

ibutio

n C

ompla

in ma

nage

ment 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

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TASK FORCES: Preparing For National Health Insurance

1. Health facilities, referral system & infra-structure

2. Finance, transformation of program & institutions, as needed

3. Regulations4. Human resources & capacity

building5. Pharmaceutical & medical devices6. Socialization & advocacy

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Preparations in line with roadmap/ action plan

Task force Tasks1. Health facilities, referral system, and infrastructure

Preparation of health care providers Strengthening of referral system by

regionalization Procurement of medical devices

Ratio: Medical doctor : 40/100.000 Dentist : 11/100.000 Midwives : 75/100.000: 4/PHC Nurses : 158/100.000: 6/PHC

Total hospital : 2.138 hospitalsTotal bed : 264.303 beds

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1

Preparations in line with roadmap/ action plan

Task force Tasks

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

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Task Force Tasks3. 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

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3Preparations in line with roadmap/ action plan

Task Force Tasks

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

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4Preparations

in line with roadmap/ action plan

HOW TO ENROLL?

Registration:

1. BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices)

2. Online registration www.bpjs-kesehatan.go.id3. Mobile customer services

HOTLINE: 500400

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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

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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

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CONCLUSION

Thank You