PROGRESS AND CHALLENGES TO ACHIEVE PROGRESS AND CHALLENGES TO ACHIEVE UNIVERSAL COVERAGE

IN INDONESIA

Prof. dr. Ali Ghufron Mukti, MSc., PhD.Vice Ministry of Health Republic of Indonesia.

Presented inPMAC BANGKOK 24 28 JANUARY 2012PMAC , BANGKOK 24-28 JANUARY 2012

Policy Objectives:

January 2014 almost all Indonesians are covered under

Policy Objectives:

January 2014, almost all Indonesians are covered under one office of Health Insurance Carrier with integrated

t f th i ti hmanagement of the existing schemes.

VARIOUSHEALTHINSURANCESCHEMESININDONESIA

YearSchemes Target Coverage

1969PTAskes CivilServant 15.500.000PT

1992PTJamsostek FormalSector 5.500.000

PoorandNear 385%In2005Jamkesmas Poor 76.400.000 patient

2003JamkesdaLocalGovInitiative 31.800.000

1992Commercial/

TheRich/bigCompanies 10.700.000

S lf i d T t l 139 900 000Selfinsured Total 139.900.000

Two Carriers Established (Social Security Carriers Law/ Two Carriers Established (Social Security Carrier s Law/ Law 24/2011, Law on Social Security (No 40/2004))

Health Insurance Carrier (BPJS Kesehatan):M i l h lth i Manage social health insurance program Started on 1 January 2014

Workmans Carrier (BPJS Ketenaga-kerjaan)( g j )Manage; Accident Benefit, life Insurance, Pension, Aged benefitbenefit, Started on 1 July 2015

4

TNI/

Scenario of Integration From Existing ManagementINFORMAL TNI/ POLRI

JKEMJAMKESMAS HEALTH LIFE WORK

INFORMAL

JkesMas+

JAMKES +

As

YKES

YKESJkes PRO

JKK +

JKEM+

JHT+

JKK+

SKem+

NON PROGRAM

JAMKESMAS(For the Poor) PROGRAM

WORK ACCIDENT

INSURANCE

OLD AGE

ACCIDENT

LIFE INSURANCE

HEA

AsKes+

S+S+

Jkes PRO

JHT+

JKesDa + JHT +

JKem +

JHT+

JPen+ Jpen+

NON PROGRAM

JAMKESDA

LIFE INSURANCE

OLD AGE

OLD AGE

PENSION

OLD AGE

PENSION

L TH

BPJS 1(Carrier 1)

BPJS 2(Carrier 2)

JKesDa + JHT + JPen+ Jpen+(Local Initiative)(Local Initiative)

OLD AGE PENSION PENSION

( ) (Carrier 2)

5FASE IIPHASE I PHASE IIPHASE II

ChallengesIndonesianIndonesia Archipelago:

Challenges

- Number of Island :17,508 E t t W t Di t 5 120 K- East to West Distance 5,120 Km(London Moscow)N th t S th Di t 1 760 KNorth to South Distance 1,760 Km

- Population 237 Million

Conceptual pFramework

Equity and

Existing Situation:1. Disintegrated

implementation and coverage

Strategy:1. Synchronisation &

integration of schemes2 Improve fund pooling

Challenges:116 activities:1. Membership

and Quality

Achieved

coverage2. Fragmented fund

pooling & management3. Limited & variations of

b fit h

2. Improve fund pooling3. Optimising benefit

package among schemes

4 Development and

MIS2. Provision of

service (114 000 benefit among schemes

4. Variations of carriers management

5. Lack of monitoring,

4. Development and improvement of carriers

5. Strengthen coordination

(114,000 Beds) & benefit package

3 Fi i (

Expected Health

Insurance Coverage

ExistingHealth

InsuranceCoverage

g,evaluation and coordination among schemes

coordination, monitoring & evaluation

3. Financing(employee)

4. Organisation and

NSSC runing well

management of carriers

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