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
• hasbullah.thabrany_at_ui.edu

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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

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The Driving Forces for Reforms1. Amendment of
the Constitution, 20022. Political Agenda?3.
Perceived Gaps4. Academic Exercises and
International Pressures
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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

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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

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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)

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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

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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

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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

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Thank You