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Background: Progress towards health-for-all must be supported by quality health facilities that are available to everyone. However, health care facilities in remote and underdeveloped areas, borderland, and outlying islands or Daerah Terpencil, Tertinggal, Perbatasan dan Kepulauan (DTPK) are facing some constraints to have access to health coverage.Aim: This study aimed to provide a comprehensive picture of the readiness of primary healthcare centers or puskesmas as the main provider of primary health services located in remote areas.Methods: Observations were taken from 18 primary healthcare centers in locations that had been identified by the government as remote and underdeveloped areas, borderland, and outlying islands in 3 provinces: Bengkulu, Nusa Tenggara Timur (East Nusa Tenggara), and South Sulawesi.Results: The findings reveal that many facilities in primary healthcare centers are still insufficient. In particular, roads to primary healthcare centers are in poor physical conditions, operational hours are too short, and doctors and lab technicians are unavailable. The good news is that primary healthcare centers have managed to run many indoor and outdoor activities, such as health education classes and detection of priority diseases in the community. Regarding primary healthcare centers’ finances, they largely depend on public funding to support their increasing expenses to provide health services, pay worker salaries, and run indoor and outdoor activities.Conclusions: Overall, some constraints faced by the primary healthcare centers in DTPK include difficult access to facilities and temporary health personnel. All of this information provides valuable inputs to policymakers in building a health infrastructure and human resources for health in DTPK. Keywords: Remote area, Human resources for health, Primary healthcare center.

While Indonesia introduced a national health insurance scheme (JKN) in 2014 and coverage has grown to over 80% of the population, Indonesians still spend significant sums out-of-pocket (OOP) for their healthcare–over 30% of current health expenditure (CHE). This study aims to better understand how JKN is influencing OOP payments, especially among the poor and rural, at the range of health facilities. This study uses data from the National Socio-Economic Survey (SUSENAS) in 2018 and 2019, as these surveys started including a question on how much OOP spending a household incurs on health. The results show that households with JKN membership are far less likely than the uninsured to pay OOP for healthcare, and that if they do incur a cost, the magnitude of this cost is much lower among JKN households than uninsured ones. The results also show that JKN households in the two poorest quintiles have a higher probability to not incur any OOP (37% and 35%, respectively) compared to those in the wealthier quintiles 4 (32%) and 5 (30%). Poorer JKN households living in the eastern part of Indonesia–the less urbanized and developed regions–experienced the most cost-savings, though largely due to supply-side constraints. In fact, JKN members save more at public primary health care facilities vs. private ones (who often do not contract with JKN) and also save significantly more (over 50%) than uninsured households at both public and private hospitals. The study demonstrates the positive influence JKN has on OOP payments, especially among the poor and rural, but also highlights how the scheme needs to better engage with the growing private sector and invest in infrastructure in rural areas to help secure financial protection for its entire population.

Set data Susenas telah mendasari banyak riset ilmiah dan kebijakan di negara kita dari tahun 1960an. Akan tetapi ada fitur-fitur Susenas yang belum dipahami benar oleh para penggunanya. Artikel ini mengangkat dua fitur yang dapat menghasilkan inferensi yang tidak akurat, bahkan tidak mendasar. Yang pertama adalah variabel pengeluaran di Susenas tidaklah mengukur pengeluaran pribadi rumah tangga, melainkan mengukur level konsumsi rumah tangga. Ini dikarenakan variabel pengeluaran di Susenas menambahkan nilai berbagai bantuan ekonomi yang diterima rumah tangga dalam pembelian barang dan jasa. Implikasinya adalah variabel pengeluaran ini yang sering lebih lanjut dipakai untuk pancaran pendapatan rumah tangga, menaksir terlalu tinggi daya beli rumah tangga berpenghasilan rendah yang mendapat banyak bantuan ekonomi, termasuk subsidi Pemerintah. Fitur Susenas kedua yang diangkat adalah adanya perubahan struktur kuesioner Susenas tahun 2015 dan selanjutnya yang dapat mengganggu analisa tren pengeluaran dari tahun ke tahun. Khususnya untuk pengeluaran kesehatan, perubahan survei ini berbarengan dengan pencapaian tahun pertama program Jaminan Kesehatan Nasional (JKN) yang dimulai di tahun 2014. Evaluasi JKN menjadi lebih rumit karena peniliti harus memisahkan dampak riil JKN terhadap penggunaan servis kesehatan dari perubahan sintesis yang disebabkan oleh perubahan desain survei.

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PurposeThe pharmaceutical industry in Indonesia appears hesitant to make the transition from inventor to innovator and instead continues with the process of formulation and packaging. Evidence-based policy has been advocated for Indonesia and, in general, this is more likely to hold. This study aims to establish a model for a policy-making process that is strategically able to predict strategies that would encourage drug development in Indonesia.Design/methodology/approachA quantitative approach with the survey method was designed to obtain appropriate data from a population of pharmaceutical industries in Indonesia and relevant government institutions to assess the relationship of various factors capable of triggering domestic drug development, including pharma capability, political feasibility and innovation incentives. The construct was validated using a set of techniques pertaining to the calculation of structural equation modeling.FindingsThe model demonstrates how it matters when applied to the policy-making process. It proves that pharma capability, political feasibility, and innovation incentives correlated to pharma capability are major catalysts in the promotion of drug development. These are largely explained by market opportunity, pull factors, government power, and position. Although all of the elements were moderately to strongly related to the promotion of drug development, this study has revealed the predictive impact on drug development in Indonesia to be only 46%.Originality/valueThis study adds values to policy-makers as it attempts to predict strategies that would encourage a successful policy when being implemented. Encompassing both pharma industries and government institutions, this study captures a real situation and provides an empirical contribution to the concept of the integrated research of drug development in developing countries.

Economically disadvantaged families often cannot pay for healthcare. Since Jaminan Kesehatan Nasional (JKN) was launched in 2014, the government expands subsidies for these families, identified based on consumption. However, this criterion would misclassify families with low purchasing power as economically advantaged because they have large consumption, financed through social assistance. This paper uses the income from the main job instead to determine families’ economic rank. Based on 35 percent of families with the lowest income, utilisation increases with insurance availability. Predictions using consumption as the gauge for economic rank are underestimated, up to 71 percent for inpatient services. .................................................... Masyarakat dengan status ekonomi rendah sering kali tidak mampu memenuhi kebutuhan kesehatannya. Sejak Jaminan Kesehatan Nasional (JKN) diluncurkan pada tahun 2014, Pemerintah memperluas subsidi iuran bagi keluarga tidak mampu yang diidentifikasi menurut nilai konsumsi. Masalahnya, kriteria ini akan mengategorikan keluarga tidak mampu sebagai mampu karena nilai konsumsi yang besar dibiayai oleh pihak lain. Sebagai alternatif, kajian ini menggolongkan keluarga berdasarkan besaran penghasilan yang didapatkan dari pekerjaan. Untuk 35 persen keluarga berpenghasilan terendah, probabilitas utilisasi ditemukan meningkat dengan ketersediaan jaminan kesehatan. Penggunaan besaran konsumsi sebagai acuan peringkat ekonomi terlalu kecil menafsir pengaruh kepesertaan jaminan kesehatan pada utilisasi, sampai sebanyak 71 persen pada pelayanan rawat inap.