Benefit Financing Package Membership Source: WHO, T he World Health Report. Health System Financing; the Path to Universal Coverage , WHO, 2010, p.12 1 Website: www.litbang.depkes.go.id
Roadmap for Achieving UHC in Indonesia Presented by Ali Ghufron Mukti Website: www.litbang.depkes.go.id
Membership Roadmap towards 96,4 million subsidy 2,5 subsidy for Universal Health Coverage KEMENTERIAN KESEHATAN people without ID REPUBLIK INDONESIA 124,3 million member Activities : be managed by BPJS 257,5 million Transformation, Integration, extention Health Program (all citizen) manage Citizen has been cover with by BPJS Keesehatan `Company 50,07 million 2014 2015 2016 2017 2018 2019 several scheme 148,2 million (Perusahaan) managed by non BPJS Big company 20% 50% 75% 100% Kesehatan Middle company 20% 50% 75% 100% Membership 90,4 million has not yet 73,8 million has not Small co 10% 30% 50% 70% 100% Satisfaction level 85% being member yet being member Micro co. 10% 25% 40% 60% 80% 100% 2012 2013 2014 2015 2016 2017 2018 2019 Transforming JPK Jamsostek, Jamkesmas, PT Integration member of Jamkesda/PJKMU Askes comercial to BPJS Kesehatan Askes to BPJS Kesehatan President Transforming Regulation of TNI TNI/POLRI POLRI Operational membership to Health Support BPJS Kesehatan Membership Extention of big company, midle, smal and micro Setting up Companies Systenm 20% 50% 75% 100% Procedure of Mapping and B Membership socialization 20% 50% 75% 100% S and Premium K 10% 30% 50% 70% 100% 100% Sinkronizing Membership Data of Membership satisfaction measurement periodically, twice a year JPK Jamsostek, Jamkesmas and Askes PNS/Sosial – using citizen ID Review of Benefit Package and Health Services Refinement 11/10/2012 Vice MoH of Indonesia 3
Benefit Package and Premium KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Same - Benefit Package Benefit Various Benefit of standart is various schemes, not package comprehensive as Activities yet based on medical medical need - Differ in hospitality needs Premium Relatively equal in term of Premium : propotion for all Various premium Differentiate between PBI from Non PBI population 2012 2013 2014 2015 2016 2017 2018 2019 Consensus Jamkes President Jamkes President Benefit package; Regulation Regulation stated on adjusted adjusted President Regulation, by Nov 2011 Review periodically on premium, benefit package effectiveness, payment adjusted to regions Premium agreed for PBI : Rp. 22.201) Premium for Non PBI still on Utilization Review to ensure efficiency, reduce moral hazard, improve going discussion : 5% of satisfaction of membership, human resources and health facility sallary 3% - 2%; 4 11/10/2012 Vice MoH of Indonesia
Health Infra-structures KEMENTERIAN KESEHATAN REPUBLIK INDONESIA - health facility • Number is enough extention and • Health facility • equal distribution development incl distribustion not optimum; • Optimal function of Activities human health various quality of services, Referral System referral helth system not resources • Prospective optimum yet; payment - Evaluastion and system not optimum yet payment system determined payment 2016 2012 2013 2014 2015 2017 2018 2019 Action plan of Implement the roadmap: facilty development, HRH, referral health facility, system, and other infrastructures HHR, referral health system and . infrastructure Periodically Review of health facility eligibility, credensialing, Quality of care, and payment and adjusted tarrif Designing Implementation, monitoring and referral health refinement and utilization review Standard and payment Implementation payment mechanism : capitation, INA-CBGs; including payment and procedure, and adjusted tarrif revised every 2 years health facility 11/10/2012 Vice MoH of Indonesia 5
Scenario of Integration From Existing Management ASURANSI INFORMAL TNI/ KOMERSIAL POLRI WORK HEALTH LIFE JKEM JAMKESMAS JAM JKK+ Jkes ACCIDENT PROGRAM INSURANCE + H KES + (For the Poor) Mas+ E LIFE Y WORK JKK + K SKem+ INSURANCE A ACCIDENT E OLD AGE HEALTH Jkes PRO As JHT+ NON PROGRAM L S + LIFE Kes+ INSURANCE OLD AGE JKem + T JHT+ INSURANCE H PENSION JAMKESDA OLD AGE PENSION JKesDa + JHT + JPen+ Jpen+ (Local Initiative) BPJS 1 BPJS 2 (Carrier 1) (Carrier 2) PHASE II PHASE I FASE II 6 Website: www.litbang.depkes.go.id
Referral Health System Hospital type A/ B Tertiary Hospital with sub-spesialist Care doctor Hospital type D/C Hospital type D: Hospital with GP Secondary & 4 basicc specialist (Obgyn, Care pediatics, surgery, internist) Health Centers, Private Clinics, private doctors Primary Care 7 Website: www.litbang.depkes.go.id
JKN PREMIUM (AMendment PRESIDENTial decree 12/2013) MEMBER DESIGN OF AMOUNT OF PREMIUM FACILITY PREMIUM Subsidies NILAI NOMINAL Rp. 19.225,- Class 3 Bed Premium Member (per life) article 16A, 23 (PBI) Gov. 5% 2% employee Class 1, Class 2 Bed Employee/Soldier (per family ) 3% employer article 16B, 23 /Police Officer/Pension Worker besides 4,5 % (per family) Up to 30 June 2015: Class 1, Class 2 Bed Gov. Employee, and 0,5% employee article 16C, 23 etc 5% (per family) 4% employer Start 1 July 2015: 1% employee 4% employer Non Worker and NILAI NOMINAL 1. Rp 25,500,- 1. Class 3 Bed Non Salary (per life) 2. Rp 42,500,- 2. Class 2 Bed Worker 3. Rp 59,500,- 3. Class 1 Bed 8 Website: www.litbang.depkes.go.id article 16F, 23
www.lkpp.go.id Website: www.litbang.depkes.go.id
THANK YOU Website: www.litbang.depkes.go.id
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