Health Policy Assesment 1

7/24/2019 Health Policy Assesment 1

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THE HEALTH POLICY

A. Introduction

Until now, health problems remains a major topic in selurruh world. The

World Health Organization (WHO) and the World Ban !roup on "# $une #%"&

showed that '%% million people do not hae access to essential health serices and

* o+ people in countries o+ low and middle income were tipped into or pushed

+urther into etreme poert- because o+ health spending. ccording to the WHO

to address health issues should be in charge o+ health polic-. ccording to WHO

health polic- re+ers to decisions, plans, and actions taen to achiee certain health

care in the communit-. /plicit health polic- can accomplish seeral things0

de+ine a ision +or the +uture which in turn helps to set targets and a re+erence

point +or the short and medium term. 1t outlines priorities and the epected role o+

the di++erent groups2 and builds consensus and in+orms people.

3o also is the case in 1ndonesia, the cost o+ treatment is still considered er-

epensie. There+ore, the eistence o+ public health insurance is needed in terms

o+ health care. To achiee national health insurance establishes health. There+ore,

the 1ndonesian goernment issued a polic- that clearl- regulate health care +or

3erants and 4ension 5ecipients (ciil and militar-) and their +amil- members

under 4residential 6ecree 7o. #8% 9ear ":;, the


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as oluntar- participants. 1n "::# re+ers to !oernment 5egulation 7o. o+ "::#

4erum status was changed to Aimited Aiabilit- ?ompan- (4T 4ersero) with

consideration o+ the +leibilit- o+ +inancial management, contribution to the

!oernment negotiated +or the bene+it o+ participants and management serices to

more independent. 1n #%%& eperienced 4T.

ses (4ersero) was gien the tas b- the !oernment through the


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B. History of Health Insurance in Indonesia

3ince ":; the goernment has launched a healthcare costs as seen +rom those

contained in the histor- o+ its deelopment, namel-0

". ":;0 The 1ndonesian goernment issued a polic- that clearl- regulate

health care +or 3erants and 4ension 5ecipients (ciil and militar-) and

their +amil- members under 4residential 6ecree 7o. #8% 9ear ":;, the


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7).

#) 5un and solidi+- the health care insurance s-stem that ise++ectie, e++icient and Fualit- to participants through a

partnership with the optimal health +acilities.

8) Optimizing the management o+ social securit- +unds and

+unds programs B4$3 e++ectie, e++icient, transparent and

accountable to support the sustainabilit- o+ the program.

') 6eelop an e++ectie Health B4$3 based on the principles

o+ good corporate goernance and improe the competence

o+ emplo-ees to achiee superior per+ormance.

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&) 1mplement and deelop a s-stem o+ planning and

ealuation, assessment, Fualit- management and ris

management oer the entire operation o+ B4$3.

) 6eelop and strengthen in+ormation and communication

technologies to support the operationalization B4$3 Health.

E. Orani!ers Health "er#ices

Health care proiders include all health +acilities that collaborates with health

B4$3 better health +acilities owned b- the !oernment, Aocal !oernment, and

the priate sector to meet the reFuirements through the process redensialing and

reredensialing

$. The Insured

". /er-one, including +oreigners who wor +or a minimum o+ (si)

months in 1ndonesia, which has been pa-ing dues, including0

Bene+iciaries Health 1nsurance ?ontribution (4B1)0 the poor and

people can not a++ord, with the determination o+ the participants in

accordance with

legislation.

#. 7on Bene+iciaries Health 1nsurance ?ontribution (7on 4B1),

comprising

+rom 0

") Wages o+ worers and members o+ their +amilies 5ecipients0

!oernment emplo-ees,T71 members,


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widow, widower or orphan +rom other pension recipients who

receie pension rights, @eteran, pioneer 1ndependence, Widow,

widower or orphan o+ a @eteran or 1ndependence 4ioneers,

Worers who are not able to pa- dues.

Uniersal health insurance is epected to start graduall- in #%"'

and in #%":, 1ndonesia is epected that all citizens alread- hae health

insurance.

%. The Borne $a&ily Me&'ers

". 5eceier worer Wages0 The nuclear +amil-, including wi+e

husband and children are legitimate (biological children,stepchildren and or adopted children), a maimum o+ & (+ie)

people. Biological children, stepchildren o+ a alid marriage.

#. 7ot or hae neer been married or do not -et hae their own

income was #" (twent-Eone) -ears old or not -et #& (twent-E+ie)

-ears o+ +ormal education is still continuing.

8. ot 5eceier Wage Worers and 7on Worers0 4articipants can

include +amil- members who desired

(unlimited).'. 4articipants can include additional +amil- members, which include

the 'th child and so on, +ather, mother and inElaws

&. 4articipants can include additional +amil- members, which include

other relaties such as siblings inElaw, household assistants, etc.

H. Contri'ution

(. =or participants Bene+iciar- ?ontribution (4B1) Health 1nsurance

dues paid b- the !oernment.

). ?ontribution to the participants o+ Aabor Wage 5ecipients who

wors at the 1nstitute o+ !oernment consists o+ the ?iil 3erice,

members o+ the militar-, members o+ the police, state o++icials, and

emplo-ees o+ nonEgoernment ciil serants b- &* (+ie percent)

o+ the salar- or wages per month with the +ollowing proisions0 8

* (three percent) is paid b- the emplo-er and #* (two percent) is

paid b- the participants.

*. ?ontribution to the participants o+ Aabor Wage 5ecipients who

wor in stateEowned enterprises, and priate enterprises o+ '.&*

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(+our point +ie percent) o+ the salar- or wages per month proided

that0 '* (+our percent) paid b- the /mplo-er and %.& * (zero point

+ie percent) is paid b- the participants.

+. =ees +or additional +amil- worers Wage 5ecipients consisting o+ '

onwards to the child, +ather, mother and inElaws, the amount o+

dues amounting to "* (one percent) o+ the salar- or wages per

person per month, paid b- worers wage earners.

,. =ees +or other relaties o+ the worers wage earners (such as

sibling inElaw, household assistants, etc.)2 participants not worer

wage earners as well as the contributions o+ participants not worer

is0

a. mounting to 5p.#&.&%%, E (twent- +ie thousand +ie

hundred rupiah) per person per month with serice bene+its

in the treatment room ?lass 111.

'. mounting to 5p.'#.&%% (+ort-Etwo thousand +ie hundred

rupiah) per person per month with the bene+its o+ serices

in ?lass 11 treatment rooms.

c. mounting to 5p.&:.&%%, E (+i+t-Enine thousand +ie

hundred rupees per person per month with serice bene+its

in the treatment room ?lass 1.

-. ?ontribution Health 1nsurance +or @eterans, 1ndependence

4ioneers, and the widow, widower or orphan o+ a @eteran or

1ndependence 4ioneers, the +ee was set at &* (+ie percent) o+ '&*

(+ort- +ie percent) basic salar- o+ ?iil 3erants group space 111 a

with tenure o+ "' (+ourteen) -ears per month, paid b- the

!oernment.

. 4a-ment o+ dues no later than "% (ten) each month

I. Health $acilities

Health +acilities in collaboration with Health B4$3 consists o+0

". Health =acilities =irst leel0

a. ?ommunit- Health ?enter (4usesmas)

b. medical practices

c. 6entists

d. The +irst clinic

e. Hospital t-pe 6

#. Health +acilities belonging to the 1ndonesian 7ational rm- (T71)

a. au. rm-0 4ol-clinic health and health posts.

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b. 7a-0 Health ?entres and 6, Balai

c. ir =orce0 ir =orce Health 3ection, Health 1nstitute o+

eronautics and 3pace (Aasepra) and 1nstitute o+ 6ental

Oral Health (Aaesgilut).d. Health +acilities belonging to the 1ndonesian 7ational 4olice

(174), consists o+ the 4arent ?linic 4olice, 4olice !eneral

4ol-clinic, 4ol-clinic Others belong to the 7ational 4olice and

The ?are Temporar- (T43) 174

8. danced Health =acilities0

a. Hospitals, consisting o+ !eneral Hospital (53U), !eneral

Hospital ?entral !oernment (6r), 53 !oernment !eneral

(Hospital), Hospital !eneral T71, !eneral HospitalBha-angara (174), !eneral Hospital 4riate, 3pecial

Hospitals, 3pecial Hospitals Heart (?ardioascular ), 3pecial

Hospital ?ancer (Oncolog-), 3pecial Hospital Aung, /-e

3pecialt- Hospital,


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b. T71 members and members o+ the militar- pension

recipients eFuialent ?iil 3erants class 1 and class room

space 11 and their +amil- members2

c. 4olice and members o+ the police pension recipients

eFuialent ?iil 3erants space group 1 and group 11 space

and their +amil- members2

d. 4articipants Worers Wage 5ecipients and 7onE

!oernment 3erants /mplo-ees with salaries or wages o+

up to ".& (one hal+) times the income is not taable to the

status o+ mating with one (") child, and their +amil-

members2 and

e. 4articipants Worers 7ot 5eceier Wages and participants

not worer with a contribution +or bene+its in the treatment

room serices class 112

8. =irst class treatment room section.

a. 3tate o++icials and their +amil- members2

b. ?iil serants and the ciil serants pension recipients

chamber group 111 and group 1@ space and their +amil-

members2

c. T71 members and members o+ the militar- pension

recipients eFuialent ?iil 3erants space group 111 and

group 1@ space and their +amil- members2

d. 4olice and members o+ the police pension recipients

eFuialent ?iil 3erants space group 111 and group 1@

space and their +amil- members2

e. @eterans and 1ndependence 4ioneers and their +amil-

members2

+. widow, widower or orphan o+ a @eteran or 1ndependence

4ioneers2

g. 5ecipients o+ the monthl- wages o+ participants Worers

and /mplo-ees o+ 7onE!oernment 3erants with salaries

or wages aboe ".& (one hal+) o+ up to two (#) times the

income is not taable to the status o+ mating with one (")

child, and their +amil- members

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h. 4eserta Worers 7ot 5eceier Wages and participants not

worer with a contribution +or bene+its in the treatment

room serice class 1.

1. Health Care %uaranteed(. Health 3erices =irst Aeel 4rimar- health care that including nonE

specialist health serices that include0 administration serices, 4romotie

and preentie, /amination, treatment, and medical consultation, 7onE

specialist medical action, both operatie and nonEoperatie, drug serices

and medical materials consumables, Blood trans+usion in accordance with

medical needs, Aaborator- diagnostic inestigations pratama leel,

Hospitalization o+ =irst 1nstance in accordance with the medical

indications.

). danced leel re+erral health serices, including health care outpatient

and inpatient care, which includes0 administration serices, /amination,

treatment and specialist consultations b- specialists and subspecialists,

3pecialist medical procedures, both surgical and non surgical according to

medical indication, 6rug serices and medical materials consumables,

danced diagnostic support serices in accordance with the medical

indications, medical rehabilitation, blood serice, =orensic medicine

serices clinic, 3erices corpse in a patient who died a+ter being

hospitalized in health +acilities in cooperation with B4$3 health, such as

the bodies pemulasaran ecluding co++in and hearse, 7on intensie

inpatient care, Hospitalization in intensie care.

*. Aabor.

Health B4$3 borne delieries in health +acilities o+ =irst 1nstance or

danced is up to the third child labor, regardless o+ the childDs li+e

death.

+. mbulance.

1n the operation o+ ambulance serices, health +acilities can cooperate with

a third part- as networing, among others0 Aocal !oernment or

4roincial Health O++ice to hae an ambulance, ambulance "";,

=oundation ambulance serice proiders

L. $lo4 Health Care

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The +irst is that participants hae to go to a health +acilit- +irst, when in need

o+ intensie action and can not be done in this health +acilit- it will be ascribed to

the second +asilits, unless in emergencies.

4rocedures to !et Health ?are

". =irst Aeel Health ?are

a. /ach participant must be registered on the +irst leel health

+acilit- that has been woring with Health B4$3.

b. 4articipants receie medical care at +irstEleel health +acilities

where participants registered.

c. 4articipants can obtain inpatient care at +irstEleel health

+acilities in accordance with the medical indications.

#. danced Health ?area. 4articipants come to B4$3 ?enter Hospital b- showing

participant card and submit a re+erral letter +rom the =irst Aeel

Health =acilities warrant control postEhospitalization.

b. 4articipants receie a Aetter o+ /ligibilit- 4articipants (3/4)

+or adanced serices.

c. 4articipants can obtain inpatient care at health +acilities in

accordance with the adanced leel o+ medical indications.

8. ?are / (/mergenc-)0

a. /mergenc- 3erices are health serices that should be proided

as soon as possible to preent death, seerit- or disabilit-,

according to the abilit- o+ health +acilities.

b. 4articipants who reFuire emergenc- serices can directl- obtain

serice in eer- health +acilit-.

c. ?riteria +or emergencies in accordance with applicable

regulations.

d. 4articipants who receie health care in health +acilities who do

not cooperate with B4$3 Health, will be immediatel- re+erredto health +acilities in collaboration with Health B4$3 an

emergenc- a+ter emergenc-.

e. resoled and the patientDs condition can be moed.

+. ?osts due to emergenc- serices billed directl- b- the Health

=asiltas B4$3 Health.

'. Health 3erices That 6o 7ot !uaranteed

a. Health serices were per+ormed without going through the

procedures as stipulated in applicable regulations.

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b. Health serices carried out in health +acilities in collaboration

with Health B4$3, ecept in emergencies

c. Health serices has been guaranteed b- the program o+ wor

injur- insurance against illness or injur- due to accidents or

emplo-ment relationship to alues coered b- accident

insurance program

d. Health serices guaranteed b- the tra++ic accident insurance

program mandator- until a alue is borne b- the tra++ic accident

insurance program

e. Health serices are per+ormed abroad

+. Health care +or aesthetic purposes

g. 3erices to oercome in+ertilit-

h. Aeeling serice dentistr- (orthodontics)i. Health disorders diseases caused b- drugs and or alcohol

dependence

j. Health problems +rom accidentall- hurting -oursel+, or as a

result o+ a hobb- which endanger -oursel+

. ?omplementar- medicine, alternatie and traditional, including

acupuncture, shin she, chiropractic, which has not been

declared e++ectie b- health technolog- assessment (health

technolog- assessment)l. Treatment and medical actions that are categorized as an

eperiment (eperimental)

m. ?ontracepties, cosmetics, bab- +ood and mil

n. Household health supplies

o. ?atastrophic health care in emergenc- relie+, etraordinar-

eents outbreas.

p. ?ost o+ other serices that are not related to health insurance

bene+its are proided.

&. ccountabilit- B4$3 HealthHealth B4$3 obliged to pa- health +acilities +or serices proided

to participants no later than "& (+i+teen) da-s +rom the claim documents

receied in +ull. The amount o+ pa-ments to health +acilities is

determined b- agreement between the association B4$3 Health and

Health =acilities in the region with re+erence to the standard rate set b-

the


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. 4a-ment esehatan.go.id

B4$3, 4articipants B4$3 3erice !uide =or Health.

Aestari, nda-ani Budi ( #%"8 ). 5ole o+ the 7ational Health 1nsurance Health

B4$3.

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http://www.bpjs-kesehatan.go.id/bpjs/index.php/pages/detail/2010/2http://www.bpjs-kesehatan.go.id/bpjs/index.php/pages/detail/2010/2http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/bpjs/index.php/pages/detail/2010/2http://www.bpjs-kesehatan.go.id/bpjs/index.php/pages/detail/2010/2


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WHO,http0www.who.inttopicshealthIpolic-en

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http://www.who.int/topics/health_policy/en/http://www.who.int/topics/health_policy/en/

Documents

Health Policy Assesment 1