MOVING TOWARDS UNIVERSAL HEALTH ACCESS IN INDONESIA

1. 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

2. OUTLINE 1.INTRODUCTION 2. EXISTING HEALTH INSURANCE IN INDONESIA 3. POLICY & DESIGN OF INDONESIA’S NATIONALHEALTH INSURANCE SCHEME 4.CONCLUSION 2

3. 1. INTRODUCTION

4. About Indonesia  World’s largest archipelago – 17,000 islands  World’s 4th most populated nation - 230million people, unevenly distributed • World’s largest Moslem population • Strong cultural and religious values

5. INDONESIAN HEALTH FINANCING 2011 • GDPper capita US$ 3,494 • Total Health Expenditure  Rp214,9 Trillion, • 2.9% of GDP • Per capita Health Expenditure  US$ 101.10 • 37.5% from public spending, • 61.4% from privatespending • 72%of population  now covered by insurance (various schemes), • 28%of population  uninsured

6. National Social Security System Law No. 40/2004 The purpose: To guarantee protection and social welfare for all people The essence: To synchronize implementation of social security in Indonesia

7. 1 2 4 5 3 Components of Social Securitysystem Health Insurance Accident insurance Old age pension Public pension Lifeinsurance

8. 1 2 4 5 3 Social Security Concept All employed citizens(in formal or informal sectors)who have income shall contribute to the program Add Your Text Basic benefits guaranteed Add Your Text Those whowish more protection, are free to purchase additional services on commercial basis Add Your Text Planned, phased implementation Government is regulator

9. 2.EXISTING HEALTH INSURANCE IN INDONESIA

10. Some Short Comings inEXISTING HEALTH INSURANCE SCHEMES Lack of integration in implementation and coverage. Fragmented fund-pooling & management Different benefit packages and limitsamong schemes Variations in management systems of different providers Limited and unevenmonitoring, evaluation andcoordination among schemes

11. EXISTING HEALTH INSURANCE COVERAGE Coverage : June 2013 176.844.161 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 %)

12. EXISTING HEALTH INSURANCE COVERAGE (JUNE 2013) 28 36.3

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

14. LEGAL FOUNDATION FOR INDONESIA’S NATIONAL HEALTH INSURANCE • Constitutionof 1945 • Act No 40/ 2004 on National Social Security System (UU SJSN) • Act No 24/2011 on Social Security Agency (BPJS) • Governmental Decree No 101/2012on Beneficiaries of Governmental subsidy (PBI) • Pres Decree No 12/2013on Social Health Insurance • Other regulations

15. ROADMAP TO UHC 86,4 mio PBI Activities: Transformation, Integration, Expansion 121,6mio covered by BPJS Keesehatan 257,5 mio (all Indonesian people) covered by BPJS Kesehatan Coverage of various existing schemes148,2mio 50,07 mio covered by other schemes Uninsured people 90,4mio Level of satisfaction 85% 73,8 mio uninsured people Transformation from 4 existing schemes to BPJS Kesehatan (JPK Jamsostek, Jamkesmas, Askes PNS, TNI Polri ) Integration of Jamkesdainto BPJS Kesehatan and regulation of commercial insurance industry Presidential decree on operational support for Army/Police Pengalihan Kepesertaan TNI/POLRI ke BPJS Kesehatan Procedure setting on membership and contribution Company mapping and socialization Membership expansion to big, middle, small and micro enterprises B S K Synchronization membership data: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single identity number Consumer satisfaction measurement every 6 month 15 Benefit package and sevices review annually

16. MEMBERSHIP • Members • All people who have paid premium • orfor 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, includingforeigners who work in Indonesia for 6 months or longer.

17. Premium of National Health Insurance

18. BENEFIT PACKAGES • Benefit package : personal health care covering promotive, preventive, curative & rehabilitative services • Benefit package : includes both medical & non medical, such as hosp accommodation, ambulanceetc • Regulation stipulates services covered

19. FINANCE:CONTRIBUTION (PREMIUM) • Contribution for people below the poverty line (PBI)→ paid by central (and local) government • Contributions of members paying their own premium • Workers 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 scheme

20. HEALTHCARE 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)

21. ADMINISTRATION &MANAGEMENT • Administered by BPJS Kesehatan (single payer) • BPJS Kesehatan: managing members, healthcare providers, claims, complaints, etc • Government:(MoH, MoF, DJSN), regulates, monitorsand evaluate implementation • MoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc

22. NATIONAL HEALTH INSURANCE MINISTER OF HEALTH Government BPJS Kesehatan Regulation on delivery of health services Regulation on Quality of care, HR, Pharmaceutical, etc Regulator Contribution Contract Payment Claims Complain management Regulation on standardization of tariff Delivery of service Members Healthcare providers utilization of service Referral system 22

23. TASK FORCES:PreparingFor National Health Insurance • Health facilities, referral system & infra-structure • Finance, transformation of program & institutions, as needed • Regulations • Human resources & capacity building • Pharmaceutical & medical devices • Socialization & advocacy

24. 1 Preparationsin line with roadmap/ action plan

25. 2 Preparations in line with roadmap/ action plan

26. Preparations in line with roadmap/ action plan 3

27. 4 Preparations in line with roadmap/ action plan

28. HOW TO ENROLL? Registration: • BPJS Kesehatan Offices (Headquarter, Regional and Branch Offices) • Online registration  www.bpjs-kesehatan.go.id • Mobile customer services HOTLINE: 500400

29. 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

30. 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

31. Thank You