Challenges and Opportunities for Future Public Spending Investing in Indonesia’s Health Challenges and Opportunities for Future Public Spending Health Public Expenditure Review 2008

Indonesia’s Health System and Financing Challenges

Indonesians are living longer and child mortality has fallen dramatically

Indonesia’s Health System Challenges Stagnating Health Outcomes Geographic Inequalities Under-funding Inefficiencies (low utilization) Financially Unsustainable Limited Health Insurance Coverage Weak Stewardship

Particular challenges remain in MDG related areas Maternal mortality Child malnutrition Female literacy and access to clean water Geographical disparities

Demographic transformation will demand a different, more expensive, health care system Indonesia 1970 Indonesia 2025

Indonesia’s Health Financing Challenges Ensuring Adequate Fiscal Space Ensuring Adequate & Equitable Financing Improving Efficiency in Provider Payment Systems Enrolling Informal Sector Workers Defining Basic Benefit Package Developing Data for Decision Making (DDM)

9 Ideas for Better Health Outcomes in Indonesia Policy Options: 9 Ideas for Better Health Outcomes in Indonesia

1. Make better use of existing resources, while also making more resources available in the medium term

2. Increase spending on maternal health Allocate more resources for referral and institutional deliveries

3. Improve resource allocation for preventive care & allow sufficient resources for O&M

4. Devote additional resources and attention to all major public goods that determine health outcomes

5. Adjust DAU to provide incentives for local civil service reform and amend PP No. 55 to allow operational use of the DAK

6. Increase coverage of the Askeskin Program

7. Ensure financial sustainability of Askeskin by introducing cost-containment options

8. Increase efficiency by including private providers in insurance schemes

9. Improve reporting and budgeting systems as well as data availability and transparency

Thank You