The Role of Microinsurance in Achieving Universal … package and sevices review annually Synchronization membership data : JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single

The Role of Microinsurance in Achieving Universal Health Coverage

Prof. dr. Ali Ghufron Mukti, MSc, PhD

Vice Minister of Health

Republic of Indonesia

WAKIL MENTERI KESEHATAN

REPUBLIK INDONESIA

1

OUTLINE

2

1. Introduction

2. Policy and Design of National Social Health Insurance

3. Preparedness of implementation National Social Health Insurance

5. Conclusion


4. Micro-insurance

1. Introduction


EXISTING HEALTH INSURANCE COVERAGE


DETAILED OF EXISTING HEALTH INSURANCE COVERAGE

The coverage up to December 2012: 163.547.921 (68,82 % of population) consisted of :

– JAMKESMAS : 78.803.760 (33,16 %)

– ASKES PNS : 16.548.283 ( 6,69 %)

– JPK JAMSOSTEK : 7.026.440 ( 2,96 %)

– TNI/POLRI/PNS KEMHAN : 1.412.647 ( 0,59 %)

– ASURANSI PERUSAHAAN : 16.923.644 ( 7,12 %)

– ASURANSI SWASTA : 2.937.627 ( 1,51 %)

– JAMKESDA : 39.895.520 (16,79 %)


COVERAGE BY PROVINCES

0

10

20

30

40

50

60

70

80

90

100

Dal

am P

erse

ntas

e

NATIONAL COVERAGE: 70.82 %


6

2. Policy and Design of National Social Health Insurance


Regulations

Constitution 1945 The Act No 40 on National Social Security System in 2004 The Act No 24 on Social Security Agency in 2011 Governmental Decree No 101 on Governmental contribution receiver in 2012 Presidential Decree No 12 on Social Health Insurance in 2013 Other regulations still being developed, included Decree of Minister of Health


National Social Health Insurance

9

Regulator

BPJS Kesehatan

Members Healthcare providers Healthcare seeking

Delivery of healthcare

Regulation on delivery of health services

Regulation on Quality of care, HR, Pharmaceutical, etc

Regulation on standardization of tariff

Government

Referral system


Roadmap to UHC

20% 50% 75% 100%

20% 50% 75% 100%

10% 30% 50% 70% 100% 100%

`Enterprises 2014 2015 2016 2017 2018 2019

Big 20% 50% 75% 100% Middle 20% 50% 75% 100% Small 10% 30% 50% 70% 100% Micro 10% 25% 40% 60% 80% 100%

2012 2013 2014 2015 2016 2017 2018 2019

Transformation from 4 existing schemes to BPJS Kesehatan (JPK Jamsostek, Jamkesmas,

Askes PNS, TNI Polri )

Membership expansion to big, middle, small and micro enterprises Procedure setting on

membership and

contribution

Company mapping

and socialization

Consumer satisfaction measurement every 6 month

Integration of Jamkesda and commercial insurance to BPJS Kesehatan

Pengalihan Kepesertaan

TNI/POLRI ke BPJS Kesehatan

Benefit package and sevices review annually

Synchronization membership data: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single identity number

Coverage of various existing schemes 148,2mio

111,6 mio covered by BPJS Keesehatan

60,07 mio covered by other schemes

257,5 mio (all Indonesian

people) covered by BPJS

Kesehatan

Level of satisfaction 85%

Activities: Transformation, Integration, Expansion

B

S

K

73,8 mio uninsured people

Uninsured people 90,4 mio

Presidential decree on operational support

for Army/Police

86,4 mio PBI

10


Membership

• Enrolees everyone has already paid or has been paid the contribution • Enrolees consisted of: a. Penerima Bantuan Iuran (PBI) poor people and not able to pay b. Non PBI (formal workers and informal workers), included foreigners who stay in Indonesia at least 6 months.


Benefit package

• Benefit package is a personal health care covering promotive, preventive, curative and rehabilitative benefit

• The benefit package comprised of medical and non medical (accommodation and ambulance) • It is regulated for inclusion and exclusion health services


Contribution

• Pooling of fund comes from contribution from the member • Contribution for PBI, financed by central government, as a nominal • Contribution for non PBI 1. Formal worker: sharing of employees and employer as a percentage of salary/wage. 2. Informal worker: as a nominal, certain amount of money


Healthcare providers and payment methods

Healthcare providers

• Primary health care providers: Puskesmas, Private clinic, Private Doctor

• Secondary and tertiary health care providers: Hospitals both public hospitals and private hospitals Payment methods • Primary health care providers: capitation

• Secondary and tertiary health care providers: Ina-CBG’s


Administration and Management

• Administered by BPJS Kesehatan (single payer) • BPJS Kesehatan managing members, healthcare providers, providers claim, member complain, etc • Government (MoH, MoF, DJSN) will conduct monitoring and evaluation

• MoH setting regulation on delivery of health services, drug and medical devices, tariff, etc


3. Preparedness of implementation National Social Health Insurance


Task force of SJSN preparation

1. Health facilities, referral system and infrastructure

2. Financing, transformation of program and institution

3. Regulation

4. Human resources and capacity building

5. Pharmaceutical and medical devices

6. Socialization and advocacy


17

Progress

Task force Progress

Health facilities, referral system and infrastructure

• Preparing healthcare providers • Revitalization referral system by implementing

regionalization • Procuring medical devices

Financing, transformation of program and institution

• Setting contribution and tariff • Preparing transformation on program: Jamkesmas,

Askes PNS, TNI Polri dan JPK Jamsostek ke JKN • Preparing transformation from PT Askes to BPJS

Kesehatan


18

Progress

Task Force Progress

Regulation

• Arranging and passing Governmental Decree No 101 on Governmental contribution receiver in 2012 and Presidential Decree No 12 on Social Health Insurance in 2013

• Preparing other Governmental Decrees and Presidential Decrees related to SJSN

• Preparing MoH decree and BPJS regulation/procedures

Human resources and capacity building

• Developing HR mapping, formation and penempatan • Conducting trainings


19

Progress

Task Force Progress

Pharmaceutical and medical devices

• Setting drug and medical devices formulary • Preparing e-catalogue • Forming Health Technology Assessment (HTA) team

Socialization and advocacy

• Preparing socialization materials • Preparing strategy and media socialization • Conducting socialization and advocacy


20

• Based on Constitution, The Act No 40 on National Social Security System in 2004, The Act No 24 on Social Security Agency in 2011, National Social health Insurance should be implemented by the year 2014

• The coverage of National Social Health Insurance is gradually expanded from 2014 to 2019

• Implementation of National Social Health Insurance encourages some reforms, both in delivery of health services and health financing


Micro-insurance • Micro-insurance schemes are built to cover

people excluded from statutory social security, notably the workers in the informal economy and their families.

• Micro-insurance schemes often initiated and operated by organizations of civil society such as TU, NGOs, MFIs, cooperatives, community based organizations, Mutual health organizations

22

Health Micro-insurance

• direct medical costs for prevention, care and cure (fees for consultations, laboratory tests, medicines, hospitalisation, delivery.

• direct non-medical costs such as costs for transportation, food in case of hospitalisation;

• indirect costs (opportunity costs), as ill health and maternity usually cause a loss of productive time for both patients and caretakers

23

Role Micro-insurance • Exercise and preparation -- to more formal statutory national

scheme

• cover people excluded from statutory social security

• Cover some benefits (supplementary benefit) –

– direct medical cost (Prevention, cost sharing, medicine etc)

– direct non-medical (transport etc)

– Indirect cost (opportunity cost)

24

THANK YOU


25

Documents

The Role of Microinsurance in Achieving Universal … package and sevices review annually Synchronization membership data : JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single