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INDONESIAS GOVERNMENTFINANCED HEALTH COVERAGE PROGRAM FOR THE POOR AND NEARPOOR
IMPROVING PUBLIC PURCHASING AND DELIVERY OF SERVICES IN INDONESIA
INDONESIA TEAM UNICO PRESENTATION HD LEARNING WEEK 2013
40
50
30
20
50
10
30
Percentage (%)
30
15
20
Year
Percentage (%)
1995
1998
2001
2004
2007
2010
40
20
10
Poorest
3rd
5th
7th
Highest
0
Poorest
10
Economic deciles
Source: SUSENAS (2010)
Highest
Benefit package: Comprehensive, even more generous than that of other social security schemes, and has no cost-sharing or co-payments
Service delivery: outpatient and inpatient; public for primary and mix for secondary; network of Puskesmas (Health Center), public hospitals, and participating private hospitals ;
JAMKESMAS FINANCING
Program fully financed from central government revenues; about of Central Government health budget;
Annual operating budget based on estimated premium rate of IDR 6,500 per person per month = US$8 per year;
Not the true cost... Actuarial and costing estimates indicate that true cost to be 3 to 6 times higher; Other estimates suggest that Jamkesmas covers only about 1/3 of true cost of care; 2/3 supply side subsidies
JAMKESMAS PURCHASING
MOH
(25% of budget)
PUSKESMAS
GOVERNMENT: Salaries Capital Operating Costs District Health Office Envelope of Funds: IDR 1000 per month per poor (not tied to enrolment)
Fee-for-service
reimbursement
Case-based Payments
SUPPLY-SIDE CONSTRAINTS
Deficiencies in the availability and quality of services limit the availability of real benefit package; Supply-side constraints comprise all the factors that limit health care delivery at the point of service, and therefore affect availability of services. Critical shortages: In general the availability of primary care facilities is good esp. in urban, and less available in remote provinces; but only public in the network, The availability of inpatient facilities is low in comparison to other comparable countries;
CHALLENGES AHEAD
Sustainability issues: actual and projection of cost; fiscal implications; and decentralized setting including yet to be explored local contribution Expanding coverage: improving targeting mechanism; covering large informal sector Lack of results-focused provider payment mechanism : incentives to improve quality and provider performance and to attain population-level targets; Ensuring supply-side readiness
- Benefit package is not uniformly available - Supply-side constraints limit service availability