1.

Company Profile Name: PT Asuransi Kesehatan Indonesia (Persero) Line of Business: Social Health Insurance Status of Corporate: State Owned Enterprise Ownership: Government of Republic of Indonesia 100% Products: a. Social Askes (Assos) b. Jamkesmen (Health Care Program for Ministers ) c. Jamkestama (Health Care Program for Specific High State's Functionaries) d. Jamkesmas (Public Health Insurance) e. PJKMU (General Society Health Care Program) Head Office Jl. Letjend Suprapto Cempaka Putih Jakarta Pusat 10510 Indonesia Phone (hunting) : (021) 4212938 Facsimile : (021) 4212940 Website : www.ptaskes.com Vision Being a specialist and leading center of Health Insurance in Indonesia Specialist PT Askes (Persero) focuses on the program of social health insurance. Leading Center PT Askes (Persero) is able to produce reliable human resources, management information system and social health insurance management system. Mission Help the Government in the field of Health by: Providing assurance of health care benefits to certain participants (Indonesian people) through a system of effective and efficient management. Optimize the management of funds and the development of systems to provide excellent service to participants on an on going basis. Develop employees to achieve optimal performance and be one of the company's main competitive advantages. Build coordination and close partnership with all stakeholders to jointly create a quality health care. 2. External Environment 2.1 Health Services in Indonesia Health services in Indonesia are still many complained of poor patients. Health programs such as the Health Insurance (Askes) and the Community Health Insurance (Jamkesmas) through the card, not running optimally in a number of areas. Hospitals (RS) are asked not to take advance of the patient. From the Central Bureau Statistic of Indonesia (BPS) known that the percentage of residents who complained of his health did not experience a significant decrease was in the range of 30%. And it is known that the number of percentage of the Indonesian population in need of health care also increased, seen in the increase in the percentage of money treating the disease itself and the increase in the percentage of residents who perform outpatient. From this
1

information shows that there are still many Indonesian people whose need optimal health care to address health complaints. Table: Indonesian health indicators (in%). Sources: www.bps.go.id
No.
1 2 3 4 5

Indikator Kesehatan
Persentase penduduk yang mengalami keluhan kesehatan sebulan yang lalu Persentase penduduk yang mengobati sendiri Persentase penduduk yang menggunakan obat tradisional Persentase penduduk yang berobat jalan sebulan yang lalu Persentase penduduk yang rawat inap setahun terkahir

2001
25,49 58,78 30,24 38,22 0,93

2003
24,41 64,35 30,67 38,62 n.a

2004
26,51 72,44 32,87 38,21 -

2005

3)

2006
28,15 71,44 38,3 34,13 -

2007
30,90 65,01 28,12 44,14

2008
33,24 65,59 22,26 44,37

2009
33,68 68,41 24,24 44,74 2,35

2010
30,97 68,71 27,58 43,99 2,51

2011
29,31 66,82 23,63 45,80 2,10

26,68 69,88 35,52 34,43 -

Getting sick is a "luxury" that poor Indonesians cannot afford because medical services and medicines could cost them a fortune in this country. If a family member is ill, ones admission to hospital, on average will cost over 100 percent of household income. And quite often the family is forced to sell a house to pay the medical bills. So, its no surprise if people are saying "If you are the poor in this country, you cannot afford to fall sick. But, there is a hope for the poor because the government is now runing a plan to provide all poor people with health insurance in 2014, so that every body in the country will then have access to health care. " 2.2 Insurance Developments In Indonesia The insurance industry in Indonesia has grown rapidly in recent years. Insurance industry grows up to 2012 the number of life insurance companies sector by 43 companies, and insurance companies as much as 80 corporate sector losses. Meanwhile both the insurance industry sector revenues life and loss until the third quarter of 2012 increased by 25.6% (source: http://www.solopos.com). But currently, however, around 36.88 percent of the country,s 238 million population is still not covered by government health insurance. Health insurance coverage in 2011 reached 63.12 percent of the 237.6 million total Indonesian population. The remaining 36.88 percent has not yet been covered.Many people who are not yet covered by the health insurance system have to pay directly to health service providers. This could make people become poor, while health service providers could tend to give poorer service to make big profits. 2.3 Sistem Jaminan Sosial Nasional (SJSN) Expectations of the Indonesian people who want social security to their lives, will soon be realized after the enactment BPJS for organizing the National Social Security System (SJSN). This desire is inspired by other countries, such as Canada and Germany. In countries which had already imposed the UU of Social Security, the people have gained health insurance, pensions and employment. In fact, some of these countries also provide
2

guarantees for those who do not have jobs. Therefore, the presence of these BPJS welcomed by a number of people, of course is understandable. Because ideally all people of Indonesia will be protected to the social security. Prinsiple & Purpose of SJSN: Principle: humanity, benefits, and social justice Purpose: Provide guarantees optimal, feasible for the participants and members of their families. SJSN Programs: Health Insurance Accident Insurance Old Age Security Retirement Security Death Benefit To help realize the national health care for all program, the parliament passed Law Number 24/2011 on the Social Security Agency (BPJS), in October 2011. The law was a government initiative to improve the peoples welfare through a health and employment security system.

The law calls for the creation of a Social Security System that will be operated by an agency to be formed by merging two state-owned companies, namely PT Jamsostek which will manage employment accident benefit, old age insurance, pension fund, and death insurance and PT Askes which was engaged in health insurance. PT Jamsostek is becoming BPJS Ketenagakerjaan and PT Askes is becoming BPJS Kesehatan. The process to merge the two companies is subject to a deadline on January 1, 2014. The law will create a single state entity in 2014 that will cover health care. Those with a regular income will have to pay monthly premiums, while the government will pay premiums for people who are poor or unemployed. The BPJS Law requires that they make fundamental changes in their operations in order to qualify as BPJS social security providers, including greater budgetary transparency and a change to non-profit status. This fundamnetal changes is called by transformation. Transformation means characteristic changes that align to BPJS philosophy. Chacaracteristic changes such as changes in organizational structure, standart operating procedure, organizational culture, etc. The intention of this transformation is to manage participants funds into benefits. When social security was managed by stated owned company its philosophy did not align with

UUD RI 1945. The aims of state owned company are to contribute to the national economy and state revenues and to pursue profit. 3. Internal Environment For PT Askes (Persero), true commitment to social security in health is not happening at the moment, at a knock Act has BPJS. Determination for change has happened since 2004, when the publication of UU Social Security (SJSN) which states that Askes (Persero) is the manager of social security in the health sector in the National Social Security System in Indonesia. The momentum was a turning point in the company's 44-year-old to transform and prepare.

Starting on January 1, 2014, PT Askes will enter a new era as the Social Security Agency (BPJS) Health. Era is not just a change of clothes, but need to balance the changes to the service system is maintained properly. There are some things that to be considered when PT Askes is transforming to BPJS Kesehatan, such as: - Adjusting in corporate culture, changing in vision and mission, since there is a differintiation between Askes as owned state company and as a BPJS Kesehatan. As a state owned company, PT Askes must contributes to the national economy and makes profit. But as a BPJS Kesehatan, Askes should considers 9 principles, such as: gotong royong (mutual relationship), keterbukaan (transparancy), kehati-hatian (circumspection), nirlaba (non-profit), akuntabilitas (accountability), profitabilitas (profitability), membership is mandatory, trust funds, and fund management results are used for the benefit of participants. - When he is as a state owned company, he must report to state owned ministry, but as BPJS, he must report to President. Moreover, as state owned company, the board of directors was chosen by ministry, but as BPJS this postion will be chosen by president and DPR. So there will be an adjusting in resources and management. - To cover larger number participants, Askes needs to adjust his resouces (such as his employee, his facilities, etc.

To adjust his resources, Askes also needs larger capital. All of Askes asset, liabilities, etc will belongs to BPJS Kesehatan. Whereas at the end of year fiscal 2012, Askes profit was declined. So, BPJS Kesehatan will face other resources barrier. - In the other hand, the fluctuation of IDR currency rate will influence the price of medicines, the price of hospitals service, the price of medical equipments, etc. During 2010-2012, PT Askes has been doing some service improvements. In 2010, PT Askes has a program to improve the image service, Askes develop and improve his masterfile, he aslo improves his IT system so in this year Askes has a real time integration information management between Askes and his hospital partners. He also has a barcode system which help askes toprovide his participants data faster and easier. Askes has a good network to cover all of Indonesia region, Askes has a branch representative in every region in Indonesia. Askes also has enough media communication which make him easier to get closer with his participants, such as hotline service, bulletin, etc. Asken has arujukan program, the purpose of this program are to utilize the Puskesmas function and to help the participant to get the easier and faster handling. But as as state owned company who has a powerful support from government, Askes does not capable enough to build a partnership with hospital, clinic, drug store, etc. We can see it from the number of private hospital who has a partnership contract with Askes, and there is no clinic who has a contract partnership with Askes. There is no good partnership with Puskesmas, so most of participants do not want to check their condition to Puskesmas. They directly go to the hospital, Askes Service centre hospital has more work load, so they can not give the best performance. This experince that make a bad image for Askes. 4. Internal Problem PT Askes According to the results of our group interview with Mrs. Andayani Budi Lestari who served as the Head of Marketing Division of PT AsKes until January 2013, and now she served as Regional Head of Central Java - Yogyakarta, there are some internal issues that need attention due to the transformation of PT Askes be BPJS Health January 1, 2014 later. And dissemination of information regarding the change itself is done in stages. Starting with socialization by Top Management to senior manager, then proceed to the manager, then proceed to the employees, this way reached for moving the role of leader of PT Askes as people manager, where the responsible supervisor on each of his subordinates. At first Askes employees worried about the change, fearing their position would be threatened, worried the company does not need them anymore. But in the end the employees also feel calm and really participate in the transformation because they were given an update on the process and the existing development. Company did a survey of all status changes perubahanm pegawaitentang perception concerns what is experienced, as well as the input and desires of employees cultural and structural transformation that occurred in the company. In addition the company also communicate about employee rights will not be reduced even may increase to employees and their families in order to really understand the process and do not panic if there are negative issues surrounding the issue of transformation is going to happen. the vision mission will change because the current Askes vision is "To be the number
5

one insurance company in Indonesia" is not in accordance with the Health BPJS which is not a company that must compete to be number one but have to provide health insurance for all Indonesian people. Until now the vision and mission is still in the drafting process, so that on 1 January 2014 the mission vision can be used. Remember if transformed into health BPJS will serve all the people of Indonesia, PT Askes requires more human resources for the smooth operation process. It was a new problem for PT Askes due course Askes to prepare large-scale recruitment, which will be followed by training and coaching. From now PT Askes already preparing for it, companies are designing the right program for recruiting, training, and coaching. Besides the old employees are also prepared to adapt to the new team members are certainly not easy to work with new people in large quantities. When our group asked whether Mrs. Andayani with the change of corporate culture, she said that will not change the corporate culture, new people coming into perusahaanlah Yag must adapt to the corporate culture Askes. The most substantial changes due to this transformation is Askes form itself. This case concerns the authority of PT Askes later after being BPJS Health became public body must have greater authority and a stronger position because it is supported by law is stronger too. Obviously these changes have made PT Askes more power in the future. 5. Changes Model (Kotter) From external and internal factors above, we analyze how the changes made using 8 stage process of creating major change by Kotter: 1. Establishing a sense of urgency As has been said earlier that Indonesia already has rules on social security set out in the National Social Security System, but with Social Security is only part of the Indonesian people who have obtained health insurance, 36.88% have not yet obtained health insurance. Though this guarantee of protection will be the responsibility of the government that is set up in the Constitution (section 28H). Countries that have similar rules on social security as well as Canada, German, Australia, has implemented social protection to all its citizens. Therefore, the Indonesian government issued a regulation on the establishment of Health Security Agency (BPJS). With this program, the government of Indonesia provides the opportunity for Askes who has 43 years services in health insurance business for the people of Indonesia as the insurance carrier for all Indonesian people. With the change of BUMN into BPJS, where the amount of the member become larger, this is a potential opportunity for Askes to grow and improve themselves because their performance will be monitored directly by the president and parliament. But this opportunity will be a boomerang for Askes, when Askes could not prepare itself well. Because the entire society to ensure the health of Indonesia, which is substantial, widespread throughout Sabang to Merauke, and the diversity of the population profession, it is not easy and differ significantly to the previous Askes business which focused on health insurance for civil servants, Ministers, etc. Because of this new BPJS will officially launched by government in January 2014, it is currently running 2 challenges, which is prepare for these changes and keep the focus on running the business now. Potential crisis

also emerged from its own employees Askes, with this change comes the concerns of employees regarding their status. 2. Creating the guiding coalition In order to the change process runs smoothly and to answer concerns the need for support of employees Askes itself, it is also gain support from other partners such as Askess agencies in military, police, hospital, health ministry, etc. To gain support from the internal, it was showed by change agent. The change agent is the person who elected in Askes, who can be trusted to carry out the plan and communicate with all the changes to the internal Askes. The change agent is not only come from the central office, but also from each unit in Indonesia. To communicate these changes, as well as practical insights, it can cooperate with each unit then the change agent is given a training first. In addition, this training also serves to train change agents in order to be a good role model. With the change agent who is trained it is expected that employees will accept and adapt easily to changes made to Askes. Remedy while building support from the exsternal, like other state agencies, hospitals, conducted by a team management approach Askes. For inter-agency approach is facilitated by the government through regulations being finalized. While building a coalition with the RS, Askes offers development potential that would be obtained if the hospital is willing to be partners in the implementation of the Health BPJS Askes this. 3. Developing a vision and strategy With the changes of form of organization, the vision and strategic Askes also change. Vision and mission should be adjusted to 9 values of the Social Security BPJS Kesehatan purpose of establishment itself, as well as tailored to the legal rules in act. If the view of BPJS Kesehatan goal is to ensure health for all people without exception and their Indonesian foreign workers that already working in Indonesia for 6 months, then use of certain words of participants is less precise. In addition it should be emphasized the use of a body or health guarantee agency entire Indonesian people without exception. Askes already in the mature level. But with the change of its name to the current Health BPJS must survive first product on the market, known by the public first. So the strategy used must be adjusted, such as multiply socialization, promotion. In addition to being BPJS Health supported by all regulations of the government, then possess a stronger bargaining power to negotiate cooperation with hospitals, clinics, health departments (for care of drug trafficking, health centers). 4. Communicating the change of vision From the data we obtained the vision and mission as a mission vision Askes still stateowned. So we are here to discuss how to communicate anything and destination changes are being made by Askes. As was previously said to facilitate internal party invite Askes (including the Ambassadors Askes) accept and adapt to changes in the existing, Askes using a trusted change agent and has been trained. In addition Askes menerpakan also the topdown approach to communication management (communication in stages). The Head of Group became the first layer as a pioneer in delivering change goals. Change leaders, employees Askes level manager, who will be responsible for implementing regulatory
7

changes made. And change agent itself, assistant manager-level employees, who will implement change programs within Askes. With this pattern coupled with the distribution of questionnaires to determine due to staff unrest is expected to further facilitate the change management team to address staff concerns Askes so the staff is also easier to accept and adapt to change. 5. Empowering broad-based action One of the most important things that is considered a change is rise the concerns of the staff Askes. They are afraid of change because it threatens their position dainggap now. However, to overcome this problem Askes've done with the right method, namely Askes actually trying to find out what their fears through questionnaires, after which the right approach, the approach through a change agent and a tiered communication Askes able to create a sense of security for its employees. Askes has declared that these changes will not be done with the layoffs, and the rights of workers remains the same normative. Askes actually give meaning to the development activities as BPJS Health Askes the greater chance of their career development. So we think this is the right communication strategy chosen and run by Askes. In addition to other challenges, namely the difficulty of monitoring the operations because it will further bertambahanya participants, then Askes already answered it began to improve management information systems and their service system. If the first partner and participant Askes difficulty in obtaining their database when being treated, and the hospital length of sulitkan with payment processing services (+ / - 3 months) then current Askes already have a system that integrates information online with its partners, the hospital. So the participant registration process does not require a long time, each partner hospitalization able to open the same database (no more double data collection for each participant now has a Membership Identification Number). As well as the consolidation process invoices and payments services to sick rumash also easier (paperless) and faster (+ / - 1 month). In addition to improving quality of care, then any partner in any Askes there Askes Centre run by the Ambassadors Askes (this is what differentiates with other health insurance). The ambassador Askes before being assigned to Askes Centre is equipped with various elatihan, such as training on product knowledge, training self and trust relations, etc. With this service, participants can easily get information about ways to use their health facilities, the faster prosesalah one handler in the hospital (prior to the Askes Centre, users Askes often in "child tirikan" by hospital officials rumash), as well as the sooner Askes know and respond to complaints from participants. In addition, one way to be prepared for change BPJS Health, Askes should remain healthy, one way it does is a commitment to stay focused on work and changes made. The commitment is realized by the mutual agreement in 2013 that overseas travel activities suspended, then if you do the trip to the regional offices in Indonesia as much as possible using the facilities Training Center (Centre for Education and Training) or if it should look for another location, then it is agreed that the location is appropriate. If assessed pogram that did not correspond with those programs welcome the changes made to the Health BPJS Askes as the work programs will be cut. In the process of this change Askes also establish internal agency known as the Transformation Implementing Organization Organisasi Pelaksana Transformasi (OPT), so
8

they are in charge of creating a way how to change in accordance with the rules of Social Security and Health BPJS, how the changes run smoothly, etc. To monitor the performance of OPT Askes form the Daily Activity Monitoring System (DAMS). 6. Generating short term wins One of the ways in which askes preparing itself for the changes to BPJS Kesehatan, which will provide non-profit health insurance for all the people of Indonesia, is to improve the quality of their services has already described above, through the development of management information systems, the education ambassador of Askes, the Askes Centre. Measurement of the quality improvements have been started in early 2012, which includes visibily measurements, such as Customer Satisfaction Index, Customer Compliance Index and level of health. And at the end of 2012, it has managed to gain 88.13 for Customer Satisfaction Index, and then managed to get an A for the level of health. This is what makes the whole Askes still hiring employees without reducing their rights. For step 7 and 8 have not been done by Askes. 6. Change Recomendation 1. Vision and Mission Changes We recommend the establishment of a new Vision and Mission determined immediately prior to 1 January 2014. So that on 1 January 2014, the vision and the mission is in conformity with the purposes and forms of health BPJS PT Askes. Original vision Askes: Being a specialist and leading center of Health Insurance in Indonesia Specialist PT Askes (Persero) focuses on the program of social health insurance. Leading Center PT Askes (Persero) is able to produce reliable human resources, management information system and social health insurance management system. Vision can be changed to: Being a public body that ensures public health services throughout Indonesia. This vision is reflected in changes in the form of business entity that initially Askes into BPJS Kesehatan. The mission should be changed and consist of 9 elements of SJSN; gotong royong (mutual relationship), keterbukaan (transparancy), kehati-hatian (circumspection), nirlaba (nonprofit), akuntabilitas (accountability), profitabilitas (profitability), membership is mandatory, trust-funds, and fund management results are used for the benefit of participants.

2. Network and Service Improvement From collected data, the number of private hospital networks Askes today is as much as 269 networks (source: www.bumn.go.id). While in Indonesia, there are approximately 544 private hospitals (source: mix.co.id), still about 50% of private hospitals in Indonesia have not been incorporated with Askess health network. In related to the basic of BPJS Kesehatans founding goals, equitable health services in Indonesia, PT Askes should undertake the development of the network number for the purpose BPJS Kesehatan can be realized. In addition, an increasing number of network is also followed by an increase in the use of

services such as Askes s member card is not difficult and can be synergized between its data throughout the health network such as hospitals, pharmacies and other health services. 3. Marketing Side In order to BPJS Kesehatans socialization can be more evenly spread throughout the community and Indonesia, Askes should promote with the form of advertisements in the print and electronic media. PT Jamsostek has already socialized BPJS Ketenagakerjaan lately. As we know, BPJS Kesehatans new program will be fully implemented on 1 January 2014. Currently in BPJS Kesehatans product introduction is still in the introductory phase. At this stage people are expected to know what exactly BPJS Kesehatan and what they will get with this Askes transformation. At this stage, more aggressive marketing activities are expected to have wide appeal. One of the promotions program is to advertise in the mass media that is currently enjoyed by the Indonesian communities such as television advertisements, newspapers and flyers distribution at hospitals or Askes health networks. 4. Human Resource Development Due to transformation to BPJS, PT. Askes starts the new step of business-life cycle: survive. In this early stage, what it should do is to invest more in building the human resources systems. As the nature of the business is service, they should invest largely on people. They need to upgrade and update their human resources. Recruitment, training and development, and succession planning are the most vital part in human resources area that they must concern on. As a governmental board, it is not their concern to set up a new salary and compensation packages due to the compliance to governments salary standard. In recruitment and selection matters, they should focus on how to recruit talented people. In order to do that, they should make competency model and dictionary. So, they could notice what kind of competencies could match to their recruitment strategy. In the training and development, they should design training methods. Mainly, they should conduct basic training because it is one of the most important training they should provide in. Basic training is urgent for new employee in order to give them what kind the organization is and what competency they need to succeed. They must be well-informed since the very beginning because it is the prerequisites for them to well-performed. Although they are a new organization, they must have succession planning. It is a plan that content of career path, in every job or position available within the organization. It provides a clear view of what are the positions and how to achieve those. However, in order to build up a succession planning, it is very important that they must build a strong structure first. One of those is organizational structure.

10