HOSPITAL STRATEGY IN THE ERA OF

UNIVERSAL HEALTH COVERAGE

Dr.dr.Sutoto,M.Kes
Chairman of the Indonesian Hospital Association
CORE DISCUSSION
SOCIOECONOMIC CHANGES IN
INDONESIA AND IMPACTS
CHANGES IN THE ERA OF UNIVERSAL HEALTH
CARE COVERAGE
5 (FIVE) INDICATIONS OFWHY INDONESIA WILL BE THE 7
TH
LARGEST
ECONOMY IN THE WORLD
1. Stable economic growth and forecast
2. Growth in urbanization. 90% of the national economic growth
is contributed by cities outside of Java.
SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS
is contributed by cities outside of Java.
3. 11% of export is not from natural resources (oil and gas)
4. 7% decrease in labor intensive industries.
5. 60% of the economy is due to the increase in productivity
Resource: McKinsey Global Institute presentation by Chairman Raoul Oberman, Indonesias Vision for 2030 ,
Indonesias National Economic Committee, Ritz Carlton Hotel, 13/ 11/ 13
G 20 MEMBERS
Ist: ECONOMIC LEVEL of INDONESIA IS ASSESSED AS
MOST STABLE IN WORLD
90 % WORLD GDP 80 % total
WORLD COMMERCE
2/ 3 % WORLD POPULATION
DEVELOPMENT Of ECONOMICS Of
INDONESIA
GROWTH OF URBANIZATION
90% of the national economic growth is contributed by cities outside of Java
60 % OF ECONOMIC GROWTH SUPPORTED BY
INCREASE IN PRODUCTIVITY
By 2030: 90 Million Indonesians could join the
Consuming Class
HOSPITAL STRATEGY IN THE ERA OF
UNIVERSAL HEALTH CARE COVERAGE
1. CORE STRATEGY
1. QUALITY IMPROVING QUALITY PERFORMANCE
2. EFFICIENCYIMPROVING EFFICIENCY
2. STEPS HOSPITAL STRATEGY TOWARD UNIVERSAL 2. STEPS HOSPITAL STRATEGY TOWARD UNIVERSAL
HEALTH COVERAGE / JKN
2. OVERALL HOSPITAL STRATEGY TOWARD UNIVERSAL
HEALTH COVERAGE/ JKN
STAGES IN IMPROVING
QUALITY PERFORMANCE
Primitive: You should do X
(X= Regulation, Standard, Incentive)
Medieval : You must do X Medieval : You must do X
Modern: X is norm (X= Check list, Default, Feed back,
Loops ex: CP)
Future : X is done (automation)
Atul Gawande, MD, Plenary Speaker, ISQuaInternational Conference 14 Oct 2013. Edinburgh, Scotland
THREE DIMENTION TOWARD
UNIVERSAL HEALTH COVERAGE
WHAT DO PEOPLE HAVE TO PAY OUT OF POCKET?
Around 150 million people suffer financial catastrophe each
year and 100 million pushed into poverty because of out-of-
FIRST DIMENSION: FINANCIAL PROTECTION
What do people have to pay out of pocket ?
Coverage mechanism VS cost sharing and fee ?
year and 100 million pushed into poverty because of out-of-
pocket health care bills (1)
Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems
Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services
PAYMENT SYSTEM :
CAPITATION FOR PRIMARY CARE
CASE BASE GROUP FOR SECONDARY AND TERTIARY CARE
HOW CAN THE MIDDLE CLASS BENEFIT
FROM THE UNIVERSAL HEALTH CARE COVERAGE?
COST SHARING TO COVER THEIR DIFFERENT NEEDS
Patients that would like to stay in higher classes can pay the
difference with private health insurance
or out-of-pocket payment,
Stated in Ministry of Health regulation PERPRES 12 TTG JAMINAN KESEHATAN. Clause 24
COVERAGE MECHANISM
(PAID BY BPJS)
COVERAGE MECHANISM
(PAID BY BPJS)
COST SHARING
COST SHARING
SHIFT OF THE PATIENT AND THE ROLE OF HOSPITALS
IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE
RS BLU
RS SN
RS PT
RS BLU
RS SN
RS BLU
RS SN
RS PT
PASIEN BPJS
PASIEN BPJS
PASIEN BPJS
(100% coverage)
PASIEN BPJS
(Additional
insurance
coverage)
PASIEN BPJS
(With option to
pay balance of
payment owing)
PASIEN BPJS
(Additional insurance
coverage)
PASIEN BPJS
(100% coverage)
IUR BIAYA
(With option to pay
balance of payment
owing)
TAHUN 2014
TAHUN 2019
TEN LEADING SOURCES OF INEFFICIENCY TEN LEADING SOURCES OF INEFFICIENCY
1. Medicine: underuse of generics and higher than necessary price.
2. Medicine: use of substandard and counterfeit medicines.
3. Medicine: inappropriate and ineffective use.
4. Products and services: overuse/ supply of equipment, diagnostic services
and procedures.
5. Health workers: inappropriate or costly staff mix, unmotivated workers.
6. Health service: inappropriate hospital admission and length of stay. 6. Health service: inappropriate hospital admission and length of stay.
7. Health service: inappropriate hospital size and low use of infrastructure.
8. Health service: medical errors and suboptimal quality.
9. Health system leakages: waste, corruption and fraud.
10. Health intervention: inefficient mix and inappropriate level.
Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems
Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services
HAVE EVER
Revenue From
Jamkesmas > 50%
STRENGTH AND WEAKNES ANALYSIS
+
HOSPITAL
HAVE EVER
SERVE JAMKESMAS
Revenue From
Jamkesmas<50%
HAVE NEVER
SERVE JAMKESMAS
Revenue FromAskes
danJamsostek>40
%
Revenue FromAskes
/ Jamsostek<40 %
-
MANAGEMENT SKILL TO CONTROL PHYSICIAN
BEHAVIOUR
MANAGEMENT SKILL
POSITIVE
ADAPTATION
PROCESS FASTER
MANAGEMENT SKILL
TO CONTROL
PHYSICIAN
BEHAVIOUR
NEGATIVE
ADAPTATION
PROCESS MORE
SLOW
SIX STEPS HOSPITAL STRATEGY TOWARD UHC/ JKN
1. 1. Develop: New Standards must be based on the national Develop: New Standards must be based on the national
standards of hospital accreditation standards of hospital accreditation
2. 2. Use of : SPOs from the international adapted accreditation Use of : SPOs from the international adapted accreditation
OVERALL
HOSPITAL STRATEGY IN THE ERA OF
UNIVERSAL HEALTH CARE COVERAGE
2. 2. Use of : SPOs from the international adapted accreditation Use of : SPOs from the international adapted accreditation
standards, standards, formularium formularium, Clinical pathways, checklists. , Clinical pathways, checklists.
3. 3. Train staff competence to execute: new accreditation Train staff competence to execute: new accreditation
standards, use of checklists, clinical standards, use of checklists, clinical pathways, pathways, ICD 10 and ICD ICD 10 and ICD
9 CM, INA CGBs and 9 CM, INA CGBs and monitoring level of monitoring level of compliance with compliance with
reward program. reward program.
Medicines Medicines::
1. 1. Improve: Electronic prescription, new prescribing Improve: Electronic prescription, new prescribing guidance, guidance,
compliance with standards and compliance with standards and formularium formularium, reduce , reduce
duplication, duplication, poli poli pharmacy, drug interaction pharmacy, drug interaction
2. 2. Incentives and support for Incentives and support for generic generic substitution substitution
OVERALL
HOSPITAL STRATEGY IN THE ERA OF
UNIVERSAL HEALTH CARE COVERAGE
2. 2. Incentives and support for Incentives and support for generic generic substitution substitution
3. 3. Regulate Regulate promotional activities, promotional activities, rational use rational use etc. etc.
Good Hospital governance Good Hospital governance: :
1. Provide 1. Provide more continuity of more continuity of care and monitoring in hospitals, clinics, care and monitoring in hospitals, clinics,
clinical clinical staff performance, staff performance, clinical Audit clinical Audit and and other monitoring other monitoring
systems. systems.
2. Implement awareness and execution of patient safety programs. 2. Implement awareness and execution of patient safety programs.
Paying Paying providers: providers:
Move Move away from fee for service to away from fee for service to remuneration. remuneration.