Indonesia: On the Way to Universal Health Care

Abstract

Indonesia has been building a National Social Security System since 2004. Formal action to build the health component in the system (National Social Health Insurance Scheme, or JKN) started in 2005. In line with the JKN roadmap, full achievement of Universal Health Care is not expected until 2019. Preparations before the launch of JKN on 1 January 2014 involved multi-level and multi-sector efforts related to issues of equity of access, coverage, finance, quality of care (infrastructure, pharmaceuticals and medical devices, medical education), management information, and fees and tariffs. This commentary by Indonesia's Minister of Health examines the preparations and first eight months of JKN, and briefly discusses these various issues as well as the policy and practices in place at the time of launch. The article includes information on the early implementation of JKN and four lessons learned from the Indonesian experience of developing and launching national social health insurance: the importance of strong political commitment; the role of comprehensive analysis of the national health system; the use of multiparty participation in developing and implementing the plans; and the importance of systematic, continuous monitoring and evaluation from technical and administrative perspectives as well as patient satisfaction, to assure progress toward Universal Health Care.

Comparison of Real Cost Versus the Indonesian Case Base Groups (INZ-CBGs) Tariff Rates Among Patients of High- Incidence Cancers Under the National Health Insurance Scheme

“…At the hospital level, JKN team has developed the INA-CBGs (Indonesian -Case Base Groups) tariff rates for healthcare payment system, which is a prospective payment method. The INA-CBGs were developed with the participation of organizations of health professionals and the Association of Hospitals, as well as extensive review of treatment standards and payments in diverse situations (Mboi, 2015). The Ina-CBGs tariff rates are based on tariff of diagnosis grouping using clinical and homogeneity of resource utilization approaches.…”

An unintended consequence of provider payment reform: The case of capitation grants in the National Health Insurance reform of Indonesia

“…While the policy objective of capitation payment reform is to promote cost-efficiency among the providers, 4 and in the case of Indonesia, to increase the overall endowment in human resources for health at the primary care level, 19,20 our findings highlight an unintended consequence of this reform in Indonesia, plausibly manifested in the form of manpower reshuffling by the government. The findings also suggest that there were substitution effects of human resources for health in the community health centres in the form of the displacement of full-time permanent health workers by contract health workers.…”

“…In the context of Indonesia, the National Health Insurance reform introduced in Indonesia in 2014 is a significant milestone in the health reform history of Indonesia, and the capitation grants distributed by the third‐party payer—known as BPJS‐Health—endows community health centres with additional resources to improve their service delivery and operational capacity . Capitation payment grants distributed to the primary health care providers under the guise of a social health insurance reform was expected to usher in additional resources for primary health providers, especially for community health centres …”

Satisfaction Level of Patients, Physicians, and Private Primary Healthcare Center Managers With Chronic Disease Management Program in Indonesia

“…Their satisfaction level was also measured using qualitative studies to carry out their perception/perspectives regarding to CDMP. An in-depth interview was performed focusing on four major factors: (1) Healthcare services, (2) capitation system in health-care program, (3) health promotion, and (4) the opportunities and challenges national health coverage in Indonesia [10].…”