PROGRESS AND CHALLENGES TO ACHIEVE UNIVERSAL COVERAGE IN INDONESIA

Prof. dr. Ali Ghufron Mukti, MSc., PhD.

Vice Ministry of Health Republic of Indonesia.
Presented in PMAC , BANGKOK 24 24-28 28 JANUARY 2012

Policy Objectives:

January 2014, 2014 almost all Indonesians are covered under one office of Health Insurance Carrier with integrated management t of f th the existing i ti schemes. h

VARIOUSHEALTHINSURANCESCHEMESININDONESIA Year Schemes 1969PTAskes PT 1992 Jamsostek Target CivilServant FormalSector Coverage 15.500.000 5.500.000 385%In 76.400.000 patient 31.800.000 10.700.000 139 900 000 139.900.000

PoorandNear 2005Jamkesmas Poor 2003Jamkesda LocalGov Initiative

Commercial TheRich/big 1992 / Companies S lfinsured Self i d Total T t l

Two Carriers Established (Social Security Carrier Carriers s Law/

Law 24/2011, Law on Social Security (No 40/2004))

Health Insurance Carrier (BPJS Kesehatan): M Manage social i lh health lth iinsurance program Started on 1 January 2014 Workmans Carrier ( (BPJS Ketenaga-kerjaan) g j ) Manage; Accident Benefit, life Insurance, Pension, Aged benefit, benefit Started on 1 July 2015
4

Scenario of Integration From Existing Management

INFORMAL
HEALTH JAM PROGRAM KES + WORK JKK + ACCIDENT LIFE JKem + INSURANCE OLD JHTAGE + LIFE JKEM + INSURANCE WORK JKK+ ACCIDENT LIFE INSURANCE
SKem+ JHT+ OLD AGE

TNI/ POLRI

JAMKESMAS Jkes Mas+ (For the Poor)

Jkes PRO NON PROGRAM

As Kes+

JHT+ OLD AGE

JAMKESDA JKesDa + (Local Initiative)

JPen+ PENSION

PENSION Jpen+

H Y E K E A S L + T H

BPJS 1 (Carrier 1) ( )

BPJS 2 (Carrier 2)

PHASE I

FASE II

PHASE II

Challenges Indonesian
Indonesia Archipelago: - Number of Island :17,508 - East E tt to W West t Di Distance t 5,120 5 120 Km K (London Moscow) N th to North t S South th Distance Di t 1,760 1 760 Km K - Population 237 Million

Conceptual p Framework
Existing Situation:
1. Disintegrated implementation and coverage 2. Fragmented fund pooling & management
Existing Health Insurance Coverage

Strategy:
1. Synchronisation & integration of schemes 2 Improve fund pooling 2. 3. Optimising benefit package among schemes 4. 4 Development and improvement of carriers 5. Strengthen coordination coordination, monitoring & evaluation

Challenges: 116 activities: 1. Membership MIS 2. Provision of service (114 000 (114,000 Beds) & benefit package 3 Financing(em Fi i ( 3. ployee) 4. Organisation and management of carriers

Equity and Quality Achieved

3. Limited & variations of b fit among schemes benefit h 4. Variations of carriers management 5. Lack of monitoring, g, evaluation and coordination among schemes

Expected Health Insurance Coverage

NSSC runing well