MOVING TOWARDS UNIVERSAL HEALTH COVERAGE IN INDONESIA 11 th ASEAN and Japan HLOM on Caring Societies Panel Discussion: Universal Health Coverage as a basis for ‘Active Aging’ and Medical and Welfare Services, Health Promotion, and Disease Prevention

Number of Island: 17,504 Population, 2012 ± 246,9 million GDP per Capita 2012 (in USD): 3,592 Decentralized Government: 34 provinces; 508 districts Life Expectancy 70,9 years (2010) Number of population 60+ years in Indonesia will increase from 18.1 million in 2010 to 29.1 million in 2020 or approximately 11.4% of the total population and 36 million in Now number of the elderly has reached about 23 million. INDONESIA

CURRENT HEALTH INSURANCE COVERAGE BY 2013

EXISTING HEALTH INSURANCE PROGRAM IN INDONESIA 1.Disintegrated implementation and coverage 2.Fragmented fund pooling & management 3.Limited & variations of benefit among schemes 4.Variations of carriers management 5.Lack of monitoring, evaluation and coordination among schemes

POLICY FRAMEWORK AND EXPERIENCE ON INCREASING ACCESS TO HEALTH SERVICES FOR INDONESIAN 5 Existing Situation: 1.Disintegrated implementation and coverage 2.Fragmented fund pooling & management 3.Limited & variations of benefit among schemes 4.Variations of carriers management 5.Lack of monitoring, evaluation and coordination among schemes Existing Situation: 1.Disintegrated implementation and coverage 2.Fragmented fund pooling & management 3.Limited & variations of benefit among schemes 4.Variations of carriers management 5.Lack of monitoring, evaluation and coordination among schemes Strategy: 1.Synchronisation & integration of schemes 2.Improve fund pooling 3.Optimising benefit package among schemes 4.Development of single carriers 5.Strengthen coordination, monitoring & evaluation Strategy: 1.Synchronisation & integration of schemes 2.Improve fund pooling 3.Optimising benefit package among schemes 4.Development of single carriers 5.Strengthen coordination, monitoring & evaluation Efforts: 6 task forces: 1.Regulation 2.Financing and Program transformation 3.Health Facilities, Referral System & Infrastructure 4.HR of health 5.Pharmaceutical and medical devices 6.Socialization Efforts: 6 task forces: 1.Regulation 2.Financing and Program transformation 3.Health Facilities, Referral System & Infrastructure 4.HR of health 5.Pharmaceutical and medical devices 6.Socialization Existing Health Insurance Coverage Existing Health Insurance Coverage Universal Health Coverage Universal Health Coverage

ROADMAP TO UHC 20%50%75%100% 20%50%75%100% 10%30%50%70%100% `Enterprises Big20%50%75%100% Middle20%50%75%100% Small10%30%50%70%100% Micro10%25%40%60%80%100% Transformation from 4 existing schemes to BPJS Kesehatan (employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme) Transformation from 4 existing schemes to BPJS Kesehatan (employee scheme JPK Jamsostek, Jamkesmas, civil servants scheme, army/police scheme) Membership expansion to big, middle, small and micro enterprises Procedure setting on membership and contribution Company mapping and socialization Consumer satisfaction measurement every 6 month Integration of Jamkesda into BPJS Kesehatan and regulation of commercial insurance industry Integration of Jamkesda into BPJS Kesehatan and regulation of commercial insurance industry membership transfer of army/police scheme to BPJS Kesehatan Benefit package and sevices review annually Synchronization membership data: JPK Jamsostek, Jamkesmas dan Askes PNS/Sosial – single identity number Coverage of various existing schemes 148,2 mio 111,6 mio covered by BPJS Keesehatan 60,07 mio covered by other schemes 257,5 mio (all Indonesian people) covered by BPJS Kesehatan Level of satisfaction 85% Activities: Transformation, Integration, Expansion Activities: Transformation, Integration, Expansion BMSBMS 73,8 mio uninsured people Uninsured people 90,4 mio Presidential decree on operational support for Army/Police 86,4 mio PBI 6

Personal health care covering promotive, preventive, curative & rehabilitative services. The benefit incudes both medical and non medical concerns such as hospital accommodation, ambulance, etc Regulation stipulates services covered 7

Health care without going through the procedures Health services in health facilities that is not contracted with BPJS Health services which is covered by covered by occupational accident insurance Health services abroad Health services for aesthethic purposes Health services for infertility (to have children) Orthodontic Health disorders/diseases caused by drugs addictions 8

Health problems related caused by activity endager himself Complementary treatment, alternative and traditional medication, including accupaucture, shin she, chiropractic and others that have not been declared by HTA Experimental medical treatment Contraseptives, cosmetics, baby foods and milk Health equipment for household Health services for disaster situation Another services which is not associated with health insurance benefits 9

Administered by BPJS Kesehatan (single payer) BPJS Kesehatan: managing members, healthcare providers, claims, complaints, etc Government: (MoH, MoF, DJSN) monitor and evaluate implementation MoH : sets regulations on delivery of health services, drug and medical devices, tariffs, etc 10

JAMKESMAS EXPERIENCE FOR ELDERLY MEMBERSHIP

PROPOSED RECOMMENDATION Increase an ability to provide our citizens with quality health care through systems that are sustainable and responsive to the health problems and health care demands, including an increasing number of elderly. Committed to provide our community with access to comprehensive and quality universal health coverage (UHC) as an investment in future socio-economic well-being. Promote regional activities on sharing information and best practices in reducing the burden of disease and cost of care as well as in focusing health promotion and disease prevention to respond an increasing trends of non- communicable disease as populations’ age and life styles change.