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

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Politics of National Health Insurance of Indonesia: A New Era of Universal Coverage Hasbullah Thabrany Institute for Social Security, University of Indonesia – PowerPoint PPT presentation

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


1
Politics of National Health Insurance of
Indonesia A New Era of Universal Coverage
  • Hasbullah Thabrany
  • Institute for Social Security,
  • University of Indonesia
  • hasbullah.thabrany_at_ui.edu

2
Conditions of 2004
  • Government financing mainly trhough supply side
    subsidy inappropriate, lost and corrupt
  • Access to Primary care is OK, but quality is poor
  • High and uncertain out of pocket public hospital
    charge fee for service
  • High burden of out of pocket 100 - 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

3
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4
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5
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6
The Driving Forces for Reforms1. Amendment of
the Constitution, 20022. Political Agenda?3.
Perceived Gaps4. Academic Exercises and
International Pressures
7
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8
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9
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10
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11
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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, concepts, etc
    from the public

13
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14
Political Interventions during Process
  • In each step, stakeholders may intervene.
  • Supports by donors GTZ, EU, ILO, WHO, ADB,
    AUSAID
  • During the process in the Parliament, 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,
    frequently voiced their oppositions
  • An analysis, threatening the Government, was sent
    by a USAID consultant
  • Organized meetings by NGOs supported by USAID to
    voice opposition with the concept

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

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

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

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

19
Thank You
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