Moving Towards Universal Health Coverage in Indonesia

1. Moving Towards Universal Health Coverage in Indonesia 11th ASEAN and Japan HLOM on Caring Societies Panel Discussion: Universal Health Coverage as a basis for ‘Active Aging’ and Medical andWelfare Services, Health Promotion, and Disease Prevention

2. INDONESIA • Number of Island:17,504 • Population, 2012± 246,9million • GDP per Capita 2012 (in USD): 3,592 • Decentralized Government: • 34 provinces; 508 districts • Life Expectancy 70,9 years (2010) • Number of population 60+ years in Indonesia will increase from 18.1 million in 2010 to 29.1 million in 2020 or approximately 11.4% of the total population and 36 million in 2025. Now number of the elderly has reached about 23 million.

3. Current Health Insurance Coverageby 2013

4. EXISTING HEALTH INSURANCE PROGRAM in indonesia Disintegrated implementation and coverage Fragmented fund pooling & management Limited & variations of benefit among schemes Variations of carriers management Lack of monitoring, evaluation and coordination among schemes

5. POLICY FRAMEWORK AND EXPERIENCE ON INCREASING ACCESS TO HEALTH SERVICES FOR INDONESIAN • Constitution • Act No 40/2004 • Act No 24/2011 • Govt decree No 101/2012 • Presidential decree No 12/2013, others Existing Situation: Disintegrated implementation and coverage Fragmented fund pooling & management Limited & variations of benefit among schemes Variations of carriers management Lack of monitoring, evaluation and coordination among schemes Strategy: Synchronisation & integration of schemes Improve fund pooling Optimising benefit package among schemes Development ofsingle carriers Strengthen coordination, monitoring & evaluation Efforts: 6 task forces: Regulation Financing and Program transformation Health Facilities, Referral System & Infrastructure HR of health Pharmaceutical and medical devices Socialization Universal Health Coverage Existing Health Insurance Coverage • External factors • Internal factors

6. ROADMAP TO UHC 86,4 mio PBI Activities: Transformation, Integration, Expansion 111,6mio covered by BPJS Keesehatan 257,5 mio (all Indonesian people) covered by BPJS Kesehatan Coverage of various existing schemes148,2mio 60,07 mio covered by other schemes Uninsured people 90,4mio Level of satisfaction 85% 73,8 mio uninsured people Transformation from 4 existing schemes to BPJS Kesehatan (employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme) Integration of Jamkesdainto BPJS Kesehatan and regulation of commercial insurance industry Presidential decree on operational support for Army/Police membership transfer of army/police scheme to BPJS Kesehatan Procedure setting on membership and contribution Company mapping and socialization Membership expansion to big, middle, small and micro enterprises B M S Synchronization membership data: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single identity number Consumer satisfaction measurement every 6 month 6 Benefit package and sevices review annually

7. BENEFIT PACKAGE • Personal health care covering promotive, preventive, curative & rehabilitative services. • The benefit incudes both medical and non medical concerns such as hospitalaccommodation, ambulance, etc • Regulation stipulates services covered

8. EXCLUSIONS (1) • Health care without going through the procedures • Health services in health facilities that is not contracted with BPJS • Health services which is covered by covered by occupational accident insurance • Health services abroad • Health services for aesthethic purposes • Health services for infertility (to have children) • Orthodontic • Health disorders/diseases caused by drugs addictions

9. EXCLUSIONS (2) • Health problems related caused by activity endager himself • Complementary treatment , alternative and traditional medication , including accupaucture, shin she, chiropractic and others that have not been declared by HTA • Experimental medical treatment • Contraseptives, cosmetics, baby foods and milk • Health equipment for household • Health services for disaster situation • Another services which is not associated with health insurance benefits

10. ADMINISTRATION AND MANAGEMENT • Administered by BPJS Kesehatan (single payer) • BPJS Kesehatan: managing members, healthcare providers, claims, complaints, etc • Government:(MoH, MoF, DJSN) monitor and evaluate implementation • MoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc

11. JAMKESMAS ExpERIENCEfor elderly membership

12. PROPOSED RECOMMENDATION • Increase an ability to provide our citizens with quality health care through systems that are sustainable and responsive to the health problems and health care demands, including an increasing number of elderly. • Committed to provide our community with access to comprehensive and quality universal health coverage (UHC) as an investment in future socio-economic well-being. Promote regional activities on sharing information and best practices in reducing the burden of disease and cost of care as well as in focusing health promotion and disease prevention to respond anincreasing trends of non-communicable disease as populations’ age and life styles change.