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FISCAL SUSTAINABILITY OF

INDONESIA’S JAMINAN
KESEHATAN NASIONAL

EFFECTIVENESS OF UNIVERSAL HEALTH COVERAGE IN ASIAN


COUNTRIES: YOGYAKARTA, MARCH 2018

ZOHRA BALSARA, PhD


Deputy Director, Health Office
USAID | Indonesia
The views expressed in this presentation are the views of the author and do not necessarily reflect the views or policies of the Asian
Development Bank Institute (ADBI), the Asian Development Bank (ADB), its Board of Directors, or the governments they represent. ADBI
does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequences of their use.
Terminology used may not necessarily be consistent with ADB official terms.
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JKN ENROLMENT PROGRESS

3/21/2018 NOT FOR DISSEMINATION 2


Coverage has increased significantly, but UHC by Jan
2019 is ambitious
Roadmap
• ~74% of population
enrolled as of Feb ‘18 (192
million people)

• Poor currently make up


48% of the enrolled
population (92.4m) -
declining as a proportion of
total enrolment

• In the latter half of 2017,


JKN added an average of
1.6 million members per
month, mostly from
informal and private
sectors – but short of
projected enrolment
3 3
Subsidized segments dominated enrolment early on,
but current growth is from contributory segments

• All segments are growing –


in 2017 most growth came
from regionally subsidized
(PBI APBD) and informal
segments

• Nationally subsidized (PBI


APBN) and public sector
segments are decreasing as
a proportion of total
enrolment – due to high
saturation early on

• Remaining growth will


continue from the informal
sector, but also needs to
increase from the private
sector
4
Evolving membership mix has financial implications –
both positive and negative

Benefits Challenges
• Average contribution will rise as subsidy • Improving collectability and re-enrolment
segments decrease as a proportion, as is increasingly relevant as membership
their contribution rate is lower shifts to contributory segments
• Reduced burden on GOI as remaining • Managing claims costs becomes more
enrolment comes from contributory relevant as utilization to date has been
sectors (private and informal sectors) highest among the informal sector 5
5
JKN FINANCIAL SITUATION

3/21/2018 FOOTER GOES HERE 6


GOI finances most scheme revenue, while costs
continue to rise, dominated by hospital care

HP+/TNP2K HP+/TNP2K

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JKN has run an increasing deficit each year, which
MOF has agreed to finance to date

2017 value

Total contributions IDR 85.69 Tril. (US$600 mil.)

Total benefit
IDR 87.22 Tril. (US$610 mil.)
expenditure
Operational
IDR 4.7 Tril. (US 33 mil.)
expenditure
Surplus or deficit IDR -6.23 Tril.* (-US$44 mil.)

Overall claim ratio 102%

Also a carried over unfinanced burden of IDR 1.8 Tril. (US$12.6 mil.) from
2016

3/21/2018 * 9 Nov 2016 Ratas Kabinet approved amount. Deficit not based on IBNR 8
Deficits will continue to rise unless contributory
segments chip in more, and better cost control measures

• Deficits need not


continue to escalate –
HP+/TNP2K new policies and
improved processes can
increase scheme
sustainability

• Opportunity to improve
claims ratio for informal
sector through targeted
efforts to increase
enrolment and
collections

• Many opportunities to
improve efficiency of
spending and control
growth in costs 9
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FISCAL SPACE FOR JKN

3/21/2018 NOT FOR DISSEMINATION 10


Indonesia: spending on health in comparative
perspective, 2014

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Central government planned spending on health, by
institution
Extraordinary allocations to
cover JKN deficit have
risen and are forecast to
become more significant this
year

2016
BKKB Other
N 3%
5%
BPOM
2%

MoH
90%

Line Ministries

3/21/2018 Source: MOF, BPJS-K. 12


JKN is increasing as a proportion of central
government spending JKN premiums
paid for the poor
has risen as a
proportion of total
central spending

Central government health budget, 2016-17


9% drop in
nominal value

HP+/TNP2K

• Central government pays a majority of subsidies for the poor, and Source:
payroll
# BPJS-K

contributions for government staff.


• Discussion underway on how local governments can increase their support for
JKN through increased contributions for full time and contractual staff.
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JKN is increasing as a proportion of central
government spending
#Source: BPJS-K

JKN cost to APBN (Central Budget)


70
60
IDR Trillions

50
40
30
20
10
0
2016 2017 2018 2019
Base scenario deficit
Base scenario PBI contribution
GOI contribution for public employees

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TERIMA KASIH!

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