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Moving Towards Universal Health Access in Indonesia: Dr. Nafsiah Mboi, Sp.A, MPH 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
REPUBLIC OF INDONESIA
MOVING TOWARDS
UNIVERSAL HEALTH ACCESS IN
INDONESIA
4. CONCLUSION
2
1. INTRODUCTION
3
About Indonesia
6
1
Health Insurance
2 Accident insurance
4 Public pension
5 Life insurance
7
1 All employed citizens (in formal or informal sectors)
who have income shall contribute to the program
Add Your Text
5 Government is regulator
8
2. EXISTING HEALTH INSURANCE IN
INDONESIA
9
Some Short Comings in
EXISTING HEALTH INSURANCE SCHEMES
11
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
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ROADMAP TO UHC
86,4 mio PBI
Procedure Company Membership expansion to big, middle, small and micro enterprises
setting on
mapping 20% 50% 75% 100%
membership B
and and
S 20% 50% 75% 100%
contribution socialization
K 10% 30% 50% 70% 100% 100%
• Members
All people who have paid premium
or for whom it has been paid
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FINANCE: CONTRIBUTION (PREMIUM)
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)
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ADMINISTRATION & MANAGEMENT
Government
BPJS
Kesehatan Regulation on delivery
of health services
Regulation on Quality of
care, HR,
Regulator Pharmaceutical, etc
Regulation on
standardization of tariff
Delivery of service
Healthcare
Members
utilization of service providers
Referral system
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TASK FORCES:
Preparing For National Health Insurance
Ratio:
Medical doctor : 40/100.000
Dentist : 11/100.000
Midwives : 75/100.000: 4/PHC
Nurses : 158/100.000: 6/PHC
25
Preparations 3
in line with roadmap/ action plan
Task Force Tasks
3. Regulation – • Dev of Government Decree No 101/2012 on
regulatory Beneficiaries of Government subsidy (PBI)
infrastructure to • Pres Decree No 12/2013 on Social Health
support imple- Insurance
mentation • Other Decrees (Presidential & Gov)
• MoH decrees, regulations, and procedures
for management of National Health
Insurance Scheme
27
HOW TO ENROLL?
Registration:
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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CONCLUSION