1 / 19

Jampersal (Maternity Insurance) as a step towards universal coverage and health equity: experience of I ndonesia *

Jampersal (Maternity Insurance) as a step towards universal coverage and health equity: experience of I ndonesia *. Soewarta Kosen Health Economics and Policy Analysis Unit, Center for Community Empowerment, Health Policy and Humanities, National Institute of Health Research & Development

thadine
Download Presentation

Jampersal (Maternity Insurance) as a step towards universal coverage and health equity: experience of I ndonesia *

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Jampersal (Maternity Insurance)as a step towards universal coverage and health equity: experience of Indonesia* Soewarta Kosen Health Economics and Policy Analysis Unit, Center for Community Empowerment, Health Policy and Humanities, National Institute of Health Research & Development Ministry of Health Republic of Indonesia *Presented at the 4th Technical Review and Planning Meeting for the Health Policy and Health Finance Knowledge Hub, Melbourne 10-11 October 2011

  2. BACKGROUND • Indonesian Constitution (1945) stated the right of every citizen to obtain health care • Indonesian Health Law (2009): right to obtain safe, accessible and quality health care • The government is responsible to provide quality health services • Social Security Law enacted since 2004, however the implementation is still fragmented

  3. COVERAGE OF HEALTH INSURANCE (2010) DistribusiPenduduk yang memilikiJaminanKesehatan (asuransikesehatan) menurutJenisJaminan Proportion of Population with health insurance • Local Health Insurance (JAMKESDA) exists in 250 districts/cities • 4 Provinces with Universal Coverage: • South Sumatra, South Sulawesi, Bali, Nanggroe Aceh Darussalam

  4. HEALTH INITIATIVES • Health Insurance for the Poor (JaminanKesehatanMasyarakat / Jamkesmas) has been implemented since January 2005 for 76.4 million (the poor and the near poor) to cover free primary healthcare services including maternity care at community health center (Puskesmas) and in-patient services in hospital wards (third class). The Ministry of Health has managed the implementation since 2008, and directly distribute the fund to Puskesmas and hospitals • A universal maternity Benefit (JaminanPersalinan/ Jampersal) is implemented since January 2011 for all pregnant women who are not covered by any maternity scheme.

  5. BACKGROUND • Health Insurance for the Poor (JaminanKesehatanMasyarakat / Jamkesmas) is delivered through 8.917 community health centers/ PUSKESMAS) and hospitals (public and private) • Maternity Insurance is delivered through physician and midwife practitioners, community health center/PUSKESMAS, maternity clinic and hospital • Fund is channelled from central to district/city through social assistance mechanism • Total budget for both programs in 2011: 6.3 Trillion Rupiahs (800 Million Au $)

  6. Seven Development Area of BAPPENAS, 2008 Source: Statistics Ind. 2008 Note: based on constant prices

  7. REASONS TO IMPLEMENT JAMPERSAL • High maternal, neonatal and infant mortality rates • Coverage of deliveries in health care facilities: 55.4 % • Decrease Contraceptive Prevalence Rate • Problems of geographical and financial access • Need to focus on delivery period and immediate post-delivery period (90 % of complications) that include: • Post delivery bleeding (28 %) • Toxaemia (24 %) • Infection (11 %) • Puerperal complication (11 %)

  8. Neonatal mortality by Island group, Indonesia, 1990 - 2015

  9. Neonatal Mortality by Wealth Group

  10. Infant Mortality Rate decreases from 35 to 34 per 1000 live births, with disparity among provinces Source: DHS 2007 MDG target for IMR: 23 per 1,000 live births by 2015

  11. Maternal Mortality Rate, Indonesia 1994 - 2007 Angka Kematian Ibu Source: DHS

  12. Disparity by quintileof income Infant Mortality Rate by quintile of income Malnutrition among children under fives by quintile of income Sumber data : SDKI 2007 Sumber data : Susenas, 2007

  13. Proportion of Safe Delivery (attended by trained health personnel) by expenditure Quintile(Susenas 2006) 94.8 Equity Index 1.67 57.9

  14. Objectives of Maternity Insurance • To increase coverage of prenatal care, delivery attendance and puerperal care by trained health personnel • To increase coverage of neonatal care by trained personnel • To increase coverage of post-delivery family planning services • To increase coverage of complication management for mothers and babies

  15. FACILITIES FOR MATERNITY INSURANCE 15 Contracted facilities (public and private)in all over Indonesia Facilities for normal pregnant women, delivery and puerperal period: * Community Health Center (Puskesmas) with or without in-patient facilities * Village Maternity Hut (Polindes * General Practitioner * Midwife Practitioner * Private Maternity Clinic • Facilities for emergency obstetric & neonatal management or complications: * Puskesmas with basic obstetric-neonatal emergency facilities * Hospitals

  16. Availability of referral facilities (public hospital and private hospital) for JamKesMas/Health Insurance for the poor, 2008 - 2010

  17. DISCUSSIONS • The Health Insurance for the poor is estimated utilized only 40 millions out of 76.4 millions of poor people • Under utilization showed by areas outside Jawa, Bali and Sumatra • Main obstacles: poor geographical access & transport facilities and limited availability of health facilities (qualified personnel, drugs, equipment , physical infrastructure) • Need special efforts to fix the situation, to achieve objectives of Maternity Insurance

  18. CONCLUSIONS • Universal coverage of Maternity Insurance as well as future social health insurance will be less effective with identified obstacles • The government should solve several “bottle-neck” that include: • hiring and placement of physicians in remote and poor area • Increase quality and distribution of midwives • Improve availability and distribution of quality health care facilitiesatprimary and referral level • Improve availability and distribution of blood banks • Improve availability and distribution of Ob-Gyn and Paediatricians in referral facilities

  19. Terima kasih

More Related