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PROGRESS AND CHALLENGES TO ACHIEVE UNIVERSAL COVERAGE IN INDONESIA

Prof. dr. Ali Ghufron Mukti, MSc., PhD.
Vice Ministry of Health Republic of Indonesia.
Presented in PMAC , BANGKOK 24 24-28 28 JANUARY 2012

h . 2014 almost all Indonesians are covered under one office of Health Insurance Carrier with integrated management t of f th the existing i ti schemes.Policy Objectives:  January 2014.

000  385% In‐ 76.400.900.700.500.000 Poor and Near  2005Jamkesmas Poor 2003Jamkesda Local Gov  Initiative Commercial The Rich/big  1992 / Companies S lf‐insured Self i d Total T t l .000  10.800.VARIOUS HEALTH INSURANCE SCHEMES IN INDONESIA Year Schemes 1969PT Askes PT  1992 Jamsostek Target Civil Servant Formal Sector Coverage 15.000  139 900 000  139.000  patient 31.000  5.500.

Law on Social Security (No 40/2004))  Health Insurance Carrier (BPJS Kesehatan): M Manage social i lh health lth iinsurance program  Started on 1 January 2014 Workman’s Carrier ( (BPJS Ketenaga-kerjaan) g j ) Manage. Accident Benefit. Aged benefit.Two Carriers Established (Social Security Carrier Carrier’s s Law/ Law 24/2011. life Insurance. benefit  Started on 1 July 2015 4  . Pension.

Scenario of Integration From Existing Management INFORMAL HEALTH JAM PROGRAM KES + WORK JKK + ACCIDENT LIFE JKem + INSURANCE OLD JHTAGE + LIFE JKEM + INSURANCE WORK JKK+ ACCIDENT LIFE INSURANCE SKem+ JHT+ OLD AGE TNI/ POLRI JAMKESMAS Jkes Mas+ (For the Poor) Jkes PRO NON PROGRAM As Kes+ JHT+ OLD AGE JAMKESDA JKesDa + (Local Initiative) JPen+ PENSION PENSION Jpen+ H Y E K E A S L + T H BPJS 1 (Carrier 1) ( ) BPJS 2 (Carrier 2) PHASE I FASE II PHASE II 5 .

760 1 760 Km K .120 5 120 Km K (London – Moscow) N th to North t S South th Distance Di t 1.East E tt to W West t Di Distance t 5.Population 237 Million .508 .Challenges Indonesian Indonesia Archipelago: .Number of Island :17.

4 Development and improvement of carriers 5. Lack of monitoring. Limited & variations of b fit among schemes benefit h 4.000 Beds) & benefit package 3 Financing(em Fi i ( 3. evaluation and coordination among schemes Expected Health Insurance Coverage NSSC runing well 7 . Synchronisation & integration of schemes 2 Improve fund pooling 2. g. Organisation and management of carriers Equity and Quality Achieved 3.Conceptual p Framework Existing Situation: 1. Disintegrated implementation and coverage 2. 3. Provision of service (114 000 (114. Optimising benefit package among schemes 4. ployee) 4. Fragmented fund pooling & management Existing Health Insurance Coverage Strategy: 1. monitoring & evaluation Challenges: 116 activities: 1. Membership MIS 2. Variations of carriers management 5. Strengthen coordination coordination.