Health Policy

Model for Thinking About Health To improve health it is important to focus policy attention on four different areas. In each area there may be public or private policy actions that can make a positive difference. These areas are: Health—Before Care (genes, individual behavior and social and physical environment) Access to Health Care (coverage, income, provider hours, transportation) Health Care Delivery (quality of care, appropriateness of care, safety of care) Monitoring Health Trends/Evaluating Policies A key assumption is the need to view health as an investment and not just as a liability cost to government and employers 2

Indonesia’s population is growing: by 2025 there will be 273 million people and the elderly population will almost double to 23 million. 3 Source: BPS 2005., world bank 2010

…but may also have serious implications for the delivery and financing of health care; doubling the need for care from aging alone. 4 World Bank Health Financing in Indonesia: A Reform Road Map.

Applying the model to helping the uninsured What should happen to reduce threats to the health of the uninsured before care is needed? What should happen to increase the chance that the uninsured afford coverage? What should happen to increase the ability of the uninsured to access care? What should happen to make sure that the uninsured get safe, appropriate care? What can we do to reduce unnecessary health spending, freeing up money for expanding coverage? 5

Although communicable disease remains a large burden, with the changing age structure disease patterns will shift to noncommunicable disease and injuries, increasing and diversifying the demand for health care further. Source: Riskesdas Survey Changes in Burden of Disease in Indonesia

 Inequities in health outcomes between income levels and geographic areas are very large and constitute a major problem for the health sector overall.

Infant Mortality Child Mortality

Indonesians live longer in 2010 and child mortality has fallen dramatically since the 1960s. 9 World Bank Investing in Indonesia’s Health: Health Expenditure Review 2008.

Despite significant reduction in IMR over time, some neighboring countries have performed better. 10 World Bank. 2009: Health Financing in Indonesia: A Reform Road Map.

And there are large inequalities between provinces and income levels. 11 Source: DHS 2007.

Life Expectancy

But geographic inequities remain large: life expectancy varies between 60 in West Nusa Tenggara and 75 in Yogyakarta. 13 World Bank Investing in Indonesia’s Health: Health Expenditure Review 2008.

Financial Protection - OOP

OOP spending, a measure of financial protection, is about average relative to comparators. 15 World Bank Health Financing in Indonesia: A Reform Road Map.

Medicine cost

In international comparisons Indonesia spends little on medicine per capita, and most expenses are out-of-pocket. Source: WHO The World Medicines Situation. 17 Over half of Indonesian districts spent less than US$0.55 per capita in 2007 and some spent less than US$0.10. Districts would need to spend around US$1.50 per capita or more on average (assuming the central government continues to provide around US$0.55 per capita for Puskesmas drugs) to provide all the primary care medicines recommended by WHO. Spending on drugs per capita in US$

But most Indonesians pay more than they need to for their medicines when they buy from the private sector or from public hospitals. Source: National Institute for Health Research and Development (NIHRD) Survey