CME Toward SDGs Implementation for Better Health of

Indonesia and the World

Ali Ghufron Mukti

Acting Minister of Research Advisor and Chairman of
Consortium of research and innovation for COVID 19

Ministry of Research, Technology/BRIN, 2020

 Introduction
• Global commitment in shaping better world
– President of RI, Prime Minister of UK, President of Liberia as co-chair in
developing draft of Post-MDGs Agenda (SGDs)
– Indonesia as a member of Foreign Policy and Global Health Initiative → UN
UHC Resolution draft
– WHO (70th anniversary) in World Health Day 2018 Universal Health
Coverage: Everyone, Everywhere. It means ensuring that everyone,
everywhere can access essential quality health services without suffering
financial hardship.
– ½ the world lack of access to essential health services, each year 100 million
people are being pushed into extreme poverty because they must pay for
health expenses out of their own pockets (WHO and WB,2017).
– The Pandemic of COVID 19 will force Indonesia and the world will work with
partnership across the globe.
Sustainable Development Goals (SGDs)
How to produce: SMART HEALHTY WEALTY HIGH COMPETETIVE HUMAN
RESOURCES WITH INTEGRITY

• Providing access of high quality of

Providing access of high quality of health care with affordable cost to all Providing basic needs of the people
education to whole population citizens (UHC) to get one billion more and empowering them to be able to
people to benefit from UHC by 2023 if develop a self-sufficient income to
we are to meet the SDGs by 2030 achieve better quality of life
• Providing health services according to
the needs of society
• Implementing intervention program
that will solve health problems in the
society according to the evidence-
based research
Responsibility of The Ministry of Research, Technology, and Higher Education (Ministry of Education), Ministry of Health
and Ministry of Prosperity (PMK) for
Improving Access of Quality Education, Health care and Prosperity
REFORMATION
IN HEALTH
SECTOR
 Reformation in Health Care system

• Health Care Financing

• Health Care Delivery System

 BPJS Kesehatan Government
(Insurance Carrier)
Regulation of health

Quality and Cost Control

system (refferral,etc)

Regulation (stadarization)
service quality; pharmacy,
Regulator medical supplies

Regulation of Health Service

Tariff and Cost-sharing
Provide Services
Health Insurance Health
Member Public Health & Goods
Searching services Facility Program Handling
Refferral system
Non member; who Handling health services in very
finally become member remote areas
 1. SITUATION OF UHC IN Indonesia a decade ago

• Population Coverage 11% : 22 Million by various schemes

• Financial Protection : heavy out of pocket 70%

• Poor and near poor people : Social Safety Net for 36 Million
people with high cost sharing and the rest have to pay (the
Poor is Forbidden to fall sick)

8 8
2. HISTORY OF UHC IN INDONESIA
 2. Evolution of UHC in Indonesia: major milestones

• 1969: Civil Servant Benefit Scheme was introduced (ASKES)

• Early 1970s: Health Card
• Early 1990s, Managed Care System was Introduced (JPKM).
• 1992: Social Security for Formal Sector Employees (JAMSOSTEK)
• After the economic crisis in 1998, a social safety net program for health was
implemented
• On October 19, 2004, Indonesia enacted the National Social Security System Law
• 2005: The Health Insurance for the Poor (covers 76.4 Million) Program was introduced
• 2005: Local government health insurance initiatives grew
• 2006: Centralized versus Integrated decentralized health insurance system
– (Constitutional Court)
• 2008: Implementing a prospective provider payment system (INA DRGs and Capitation)
• In 2010 Jampersal (Health insurance for delivery) was introduced
• 2011: Act on Health Insurance Carriers (BPJS -> merging various health insurance carriers
(plans) into one carrier (plan) and be implemented in January 2014)
 1. Government
• Completing and renewing necessary regulations
• Conducting monitoring and evaluation
• Establishing Health Technology Assessment (HTA)
• Adding Health infra-structures
• Preparing and producing human resources for health
(HRH)
• Improving data for the poor and its management
• Allocating necessary budget for the poor
 2. Membership
– Expanding of the membership targeted the whole population
will be covered in the year of 2019

– > 200 people are covered per March 2020

– Waiting time < 30 menit, services compared to non-member, co-

payment?
– March 2018 = 126,723 members of plan (JKN-KIS) use the
KESSAN (Online application)
 Benefit
Financing Package

Membership

Source: WHO, The World Health

Report. Health System Financing; the
Path to Universal Coverage, WHO,
2010, p.12
13
 Comparison of UHC Achievement in ASEAN Countries
Country (3) People Pop (2) Health service coverage (1)
Pop covered (Mill) Financial
cover (Mill) *) WHO protection*
age

Malaysia 100% 28 28 PHC services focus on MNCH. But long waiting 40.7%
time, and limited number of family physicians;
Survey reports 62% of ambulatory care was
provided by private clinics

Thailand 98% 67 69 Comprehensive benefit package, free at point of 19.2%

service for all three public insurance schemes
Indonesia 68% 163 240 Good policy intention but low per capita government 30.1%
subsidy for the poor of US$ 6 per year
Philippines 76% 70 93 High level of co-payment, 54% of the bill are 54.7%
reimbursed
Vietnam 54.8 48 87.8 Benefit package comprehensive but substantial level 54.8%
% of co-payment, 5-20% of medical bills
Lao PDR 7.7% 0.5 6 Low level of government funding support to the 61.7%
poor results in a small service package
Cambodia 24% 3 14 The poor covered by the health equity fund but the 60.1%
scope and quality of care provided at government
health facilities are limited

Source : Lancet, 2011 Financial protection * measured by OOP as % of THE, 2007

 Indonesia

Modified
 Indonesia

Indonesia

Modified
3. Health Insurance Carrier (BPJS)
• Operationalize to increase its membership and
socialization

• Collecting premium, managing collected fund and paying

to health providers

• Developing contract with health providers and making

sure the access of members to primary health care
clinics and hospitals
3. Health Insurance Carrier (BPJS)
• Deficit ? The principle of social health insurance doesn’t work
(PBI, PPU, PBPU membership), PBI balance 4.6 T or 23,3 T
(2017), PPU (12,1 T during 4 years, PBPU (16,6 T, 47.3 T during
4 years period).

• Collecting premium, managing collected fund and paying to

health providers (is it the correct method and fair?)

• Developing contract with health providers and making sure

the access of members to primary health care clinics and
hospitals
 4. Health Facilities
• Referral system
• 20.000 PHCs and private clinics
• All public hospitals and many private hospitals
• Capitation payment for PHCs
• Ina-CBGs / DRGs payment for Hospitals
• Health providers felt that payment is lower than
market price
 Health Facilities
• In March 2018, 21.893 PHCs/Clinics contracted
with BPJS;17.035 committed to be paid using a
performance based capitation (KBK), where
the 8.392 clinics are private.

• 5,337 referral health facilities (2,135 hospitals,

2,216 pharmacies, 986 optic providers).
 Benefit package
• A comprehensive benefit package/coverage (promotion, prevention,
treatment-dental care and rehabilitation
• The comprehensive benefit package is equal, however; there are
three different ward classes (amenities)
• The premium rate is equal if the benefit is equal regardless the age,
location and income level
• No pre-existing conditions
• The young and the old have the same benefit package/plan/coverage
• However; in some area the coverage is not effective
• The utilization both out-patient and in-patient rate increased
dramatically now the patients have to be in-queue
 Challenges
• Sustainability of the scheme (deficit is increasing 16.5 T rp or US1.17
billion)
• Payment mechanism and its tariff is still below market price
• Socialization and empowerment is still limited
• Membership especially from the rich and informal sectors
• The availability and the quality of the health care infra-structures
especially in remote areas
• Membership complaint resolution
• Managements and human resources
• The clearness of the roles, tasks and responsibilities of main related
institutions Such as Ministry of Health, National Social Security Board
(DJSN), Health Social Security Implementing Agency (BPJS Kesehatan),
Local Government etc.
 Conclusion
• It is our responsibility to shape better
world by implementing global
commitment on SGD’s especially Goals
No 3 “Good Health and Well-Being”.
Developing and implementing UHC is a
promising tool to achieve this goal. So
everyone, everywhere should have
access of quality health care without
facing financial hardship.
 Conclusion

• There are many challenges in implementing and

practicing the UHC program (JKN-KIS) in Indonesia,
including ethical challenges in the component of
Government, Health Insurance Carrier (BPJS Kesehatan ),
health care facilities and members or citizen of the
country. Appropriate strategic measures should be
developed to solve and anticipate these challenges.
 THANK
YOU
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