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
 OUTLINE
1. 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
 Law
No. 40/2004

The essence: The purpose:

To synchronize To guarantee
implementation of social protection and social
security in Indonesia welfare for all people

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1
Health Insurance

2 Accident insurance

3 Old age pension

4 Public pension

5 Life insurance
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1 All employed citizens (in formal or informal sectors)
who have income shall contribute to the program
Add Your Text

2 Basic benefits guaranteed Add Your Text

3 Those who wish more protection, are freeAdd

to Your Text
purchase additional services on commercial basis

4 Planned, phased implementation

5 Government is regulator
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2. EXISTING HEALTH INSURANCE IN
INDONESIA

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 Some Short Comings in
EXISTING 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 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 %)

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EXISTING HEALTH INSURANCE COVERAGE
(JUNE 2013)

28 36.3

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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

257,5 mio (all

121,6 mio covered Activities:
Indonesian
by BPJS Keesehatan Transformation, Integration, Expansion people) covered
Coverage of various existing by BPJS
schemes 148,2mio 50,07 mio covered `Enterprises 2014 2015 2016 2017 2018 2019 Kesehatan
by other schemes
Big 20% 50% 75% 100%
Uninsured people 90,4 73,8 mio uninsured Middle 20% 50% 75% 100% Level of
mio people Small 10% 30% 50% 70% 100% satisfaction 85%
Micro 10% 25% 40% 60% 80% 100%

2012 2013 2014 2015 2016 2017 2018 2019

Transformation from 4 existing schemes to Integration of Jamkesda into BPJS Kesehatan
BPJS Kesehatan (JPK Jamsostek, Jamkesmas,
Askes PNS, TNI Polri )
and regulation of commercial insurance industry
Presidential decree Pengalihan
on operational Kepesertaan
support for TNI/POLRI ke BPJS
Army/Police Kesehatan

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%

Synchronization membership data:

JPK Jamsostek, Jamkesmas dan Askes
Consumer satisfaction measurement every 6 month
PNS/Sosial – single identity number
Benefit package and sevices review annually
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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 REMARK
membership fee
(IDR)
SUBSIDIZED NOMINAL 19.225,- Class 3 IP care
MEMBER (per member)
CIVIL 5% 2% from employee Class 1 & 2 IP care
SERVANT/ARMY/POL (per household ) 3% from employer
ICE/ RETIRED
OTHER WORKERS 4,5 % Until 30 June 2015: Class 1 & 2 IP care
WHO RECEIVE (per household) 0,5% from employee
MONTHLY And 4% from employer
SALARY/WAGE
5% (per household) Start from 1 July2015:
1% from employee
4% from employer
NON WAGE NOMINAL 1. 25,500,- 1. Class 3 IP care
EARNERS/ (per member) 2. 42,500,- 2. Class 2 IP care
INDEPENDENT 3. 59,500,- 3. Class 1 IP care
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MEMBERS
 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)
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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
MINISTER OF HEALTH

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

1. Health facilities, referral system &

infra-structure
2. Finance, transformation of program
& institutions, as needed
3. Regulations
4. Human resources & capacity
building
5. Pharmaceutical & medical devices
6. Socialization & advocacy
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 Preparations 1

in line with roadmap/ action plan

Task force Tasks
1. Health facilities,  Preparation of health care providers
referral system,  Strengthening of referral system by
and infrastructure 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 hospitals

Total bed : 264.303 beds 24
 Preparations 2

in line with roadmap/ action plan

Task force Tasks

2. Finance,  Setting premiums and tariffs
transformation of  Preparing transformation of existing
programs and insurance & programs : Jamkesmas,
institutions, as Askes PNS, TNI Polri & JPK Jamsostek to
needed Nat Soc Health Ins
 Preparing transformation/ migration of
management PT Askes → BPJS Kesehatan

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 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

4. Human • Developing HR mapping, distribution, and

resources and assignment
capacity building • Design and carrying out training, as needed
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 4
Preparations
in line with roadmap/ action plan
Task Force Tasks
5.Pharmaceutical • Setting formularies for drugs and
and medical medical devices
devices • Developing e-catalogue
• Forming Health Technology Assessment
(HTA) team and their tasks
6. Socialization • Preparing strategy, materials ,and media
and advocacy for socialization of the new National
Social Health Insurance scheme
• Conducting intensive and wide-reaching
socialization and advocacy

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 HOW TO ENROLL?

Registration:

1. BPJS Kesehatan Offices (Headquarter, Regional

and Branch Offices)
2. Online registration  www.bpjs-kesehatan.go.id
3. 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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 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
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Thank You