Politics of National Health Insurance of Indonesia: A New Era of Universal Coverage

Hasbullah Thabrany Institute for Social Security, University of Indonesia hasbullah.thabrany@ui.edu
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lost and corrupt • Access to Primary care is OK.240% of monthly income for a single hospitalization: 83% households needed inpatient care experiences catastrophic health expenditures • Corporatization and “privatization” of public hospitals: increasing financial barriers 2 H Thabrany/ISS UI . but quality is poor • High and uncertain out of pocket: public hospital charge fee for service • High burden of out of pocket: 100% .Conditions of 2004 • Government financing mainly trhough supply side subsidy: inappropriate.

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Amendment of the Constitution. 2002 2.The Driving Forces for Reforms 1. Perceived Gaps 4. Academic Exercises and International Pressures H Thabrany/ISS UI 6 . Political Agenda? 3.

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concepts. etc from the public H Thabrany/ISS UI 12 .Political Process • The Indonesian Law process – Government submit a Bill-discuss by Parliament and the Government – Parliament initiate a Bill-response by the Government by sending ‘partner’ to be discussed together • Both initiatives solicit ideas.

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threatening the Government. stakeholders may intervene. frequently voiced their oppositions • An analysis. AUSAID • During the process in the Parliament. was sent by a USAID consultant • Organized meetings by NGOs supported by USAID to voice opposition with the concept 14 Political Interventions during Process H Thabrany/ISS UI . ILO.• In each step. ADB. • Supports by donors: GTZ. EU. WHO. demos of to support or to reject the Bill have been made by Employer and Employee Associations • Opinions also published through News and Articles in newspapers and magazines • International Bussiness Chamber of Commerces.

• Administration of the scheme undertook by Askes. the new government.The Askeskin. especially by HMOs (JPKM) H Thabrany/ISS UI 15 .7 million the poor. 40 years experienced with more than 280 branch offices • Criticisms and complaints were sent. paid the first contribution for 36. promising free health care before. Government Sponsored Insurance for the Poor • Starting January 2005. the administrator for National SHI for civil servants.

administration by Askes was truncated to only membership administration. But the official at MOH continue to administer the fund by themselves H Thabrany/ISS UI 16 . It was rejected • Two years after Askes administered. claiming the HI is a provincial jurisdiction. No misconduct was found. Claim by hospital paid directly by MoH • Financial audit was undertaken. East Java Province. accusation of mismanaged fund by Askes voiced by some MoH officials • In 2008.Two Months After Government Paid the First Contribution • The law was challenged to the Constitutional Court by provincial legislative.

Although it is actually by a quasigovernment autonomy body • Shared contribution by employees • Integration of the system into a single scheme • Demand for provincial control on fund management H Thabrany/ISS UI 17 .After almost five years. the law has not been implemented and objections are on: • Mandatory system • Monopolistic system/central government control system.

premiums.Conclusion • Indonesia has long implemented social health insurance. but many resistances and trials (including political “lipsticks” promising “free health care” by candidates of governors) are being voiced H Thabrany/ISS UI 18 . This improvement is being undertaken • A National Health Insurance Program was passed. management. and payment to providers. but it grows very slowly due to inconsistent implementation of SHI principles • Current SHI implementation needs improvement in benefits.

Thank You H Thabrany/ISS UI 19 .

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