Trisnantoro, Marthias and Harbianto (from the Centre for Health Policy and Management, School of Medicine, Gadjah Mada University) in Indonesia, wrote an assessment of their country’s progress towards universal health coverage for GNHE.
You can read the full assessment here.
The authors’ conclusions are:
- The burden of health financing in Indonesia is mildly progressive
- The distribution of utilisation is also mildly progressive, particularly for hospital inpatient care
- Indonesia’s out-of-pocket payments are still at a very high rate because of user fees across the system and the large proportion of the population that remains uninsured
- Catastrophic payments probably still burden many of the poor while utilisation by the poor is low relative to their need for health care
- The complexity of the financial protection system has introduced distortions into funding flows and the provision of care
- Risk pools have also been fragmented
- To address these problems, the Indonesian government has initiated the implementation of its first universal health coverage program, National Health Insurance or BPJS
- The intention is to unify all the old health schemes, creating one large risk pool
- The coverage of the new scheme was almost 122 million people in 2012. The intention is to insure all 258 million Indonesians by 2019, including foreigners who work in the country for more than six months
- The new scheme is funded through a mixture of government subsidies and premiums
- There will be a nation-wide, single benefit package that is comprehensive, except for some limits and exclusions
- The scheme will practise active purchasing with accredited providers (including capitation and Indonesian DRGs), negotiate with providers around cost control, and implement mechanisms to improve quality
- Gate-keeping by primary care providers is an important strategy to improve health system efficiency
- In conclusion, financial protection should be regarded as one aspect of universal health coverage and not the sole agenda for Indonesia. Intensive investment is required to ensure supply-side readiness, so that equitable health care utilization and health attainment can be achieved even in the currently under-developed regions of Indonesia.
Trisnantoro L, Marthias T, Harbianto D. 2014. Universal health coverage assessment: Indonesia. Global Network for Health Equity (GNHE). Available at: http://gnhe.org.