CHALLENGES TO IMPLEMENTINGTHE NATIONAL HEALTH INSURANCE PROGRAMME

Irrational Drug Prescription

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INN Generic Drugs are Cheaper in Indonesia than in other Countries (Single Buyer)

By 2019 almost all provinces will experience a shortage of doctors, hospitals & nurses

Antibiotic Use

Challenges to supplying medicines under the JKN programme

Tantangan Utama Penyediaan Obat Untuk Program JKN

Affordable price

Ensuring availability of medicines

Availability of appropriate drugs 2

1

3Improvement of National Drug

Procurement System

Source: Drug Availability Study in JKN Era – TNP2K, Harvard Medical School, and IMS Indonesia 2014

The biggestshortage will be

felt in the supply of doctors.

Provinces that enjoy asurplus continue to be

plagued by unevendistribution and quality.

Though there will be asurplus of midwives,

uneven distribution andquality will continue to

be a challenge

Price Structure of Branded Generic Drugs in Indonesia

Metformin Raw Material Price 6% Import Duty 0.3%

Manufacturing Cost 8% Distributor Discounts 3%

Sales & Marketing Employee & Overhead Cost 12%

Sales & Marketing Cost 18% Admin Employee & Overhead 9%

Pharma Company Profit 4% Distributor Margin 6%

VAT 7%

Retailer Margin 18% VAT 9%

Consumer Price 100%

Contoh:Struktur Harga Metformin Bermerk

Sumber: TNP2K

54% 10% 17%

19%

Biaya produksi Sales & marketing

Profit

Pajak

Struktur Harga Obat Generik Bermerek di Indonesia Biaya Produksi, Penjualan, Pemasaran, Pajak dan Keuntungan Retail

Sales &Marketing

Procurement System at Drug Distribution Facilities in Indonesia

Source: TNP2K dan IMS Indonesia

2014 e-Catalogue Implementation: Challenges

Source: TNP2K

123

Direct Procurement

Tender

e-Cataloque

Generic Drugs are More Expensive in Indonesia than in other DevelopingNations

22Shortage

12 SurplusEast Papua, Papua, North Maluku, North Sulawesi,Central Sulawesi, North Kalimantan, East Kalimantan, East Sulawesi, DKI Jakarta, Bengkulu, Riau, Aceh

CriticalLampung, South SulawesiCentral Java, East Java

32Shortage

2 SurplusYogyakarta & Riau

CriticalLampung, Central Java, East Java, West Java

Doctor

24Shortage

10 SurplusWest Papua, Papua, NTB, Yogyakarta, East Java, West Java East Sulawesi, Banten, Babel, Bengkulu

CriticalSouth Sulawesi,Lampung, DKI Jakarta, Central Jawa

Hospitals Nurses

Role of the Health Ministry LKPP Role

Metformin Raw Material Price 6% Import Duty 0.3%

Manufacturing Cost 8% Distributor Discounts 3%

Sales & Marketing Employee & Overhead Cost 12%

Sales & Marketing Cost 18% Admin Employee & Overhead 9%

Pharma Company Profit 4% Distributor Margin 6%

VAT 7%

Retailer Margin 18% VAT 9%

Consumer Price 100%

Contoh:Struktur Harga Metformin Bermerk

Sumber: TNP2K

54% 10% 17%

19%

Biaya produksi Sales & marketing

Profit

Pajak

Struktur Harga Obat Generik Bermerek di Indonesia Biaya Produksi, Penjualan, Pemasaran, Pajak dan Keuntungan Retail

IndonesiaBrazilIndiaGermanyFrance

Drugs Management Information System

National Formularium

Implementation of the e- catalogue system

1

2 Plan for the need for drug 4

35 Other Mechanisms as stated

in Presidential Regulation 70/2012

Drugs Management Information System

National Formularium

Implementation of the e- catalogue system

1

2 Plan for the need for drug 4

35 Other Mechanisms as stated

in Presidential Regulation 70/2012

.............................................................................

Supply Side Challenges45.0

40.0

Diagnosed Hypertension andUnmet Needs by Province

BAN

TEN

DKI JA

KARTA

PAPU

A

LAM

PUN

G

LAM

PUN

G

EAST PA

PUA

R

Sources : Riskesdas 2010

35.0

30.0

25.0

20.0

15.0

10.0

5.0

45.0

40.0

5.0

SOU

TH KA

LIMA

NTA

N

EAST JAVA

WEST SU

LAWESI

EAST SU

LAWESI

CENTRA

L SULAW

ESI

BABEL

DI YO

GYA

KARTA

RIAUN

TB

SOU

TH SU

MATRA

MA

LUKU

SOU

TH EA

ST SULAW

ESI

JAM

BI

CENTRA

L KALIM

AN

TAN

BALI

EAST SU

MATRA

NO

RTH M

ALU

KU

SOU

TH SU

LAWESI

NTT

KEPRI

GO

RON

TALO

EAST KA

LIMA

NTA

N

EAST KA

LIMA

NTA

NN

ORTH

SUM

ATRA

ACEHEA

ST JAVA

NO

RTH SU

LAWESI

35.0

30.0

25.0

20.0

15.0

10.0

People continue to have to queue to receive medical care

$

7

6

5

4

3

2

1

9

8

Cefotaxime(dry vial 1g)

1.841.52

9.32

0.49

Metformin(tab 500 mg)

0.01 0.02 0.05 0.02

14

12

10

8

6

4

2

0Cefotaxime(dry vial 1g)

Terbutaline(amp 500Y/1L)

Valsartan(tab 80 mg)

Paclitaxel(vial 6 mg/1 ml)

$

8.92

2.51

1.28 1.14 0.820.01 0.58 0.09 0.13

12.03

0.53

4.97

Production cost

Sales & marketing

Pro�ts

Tax

Cephalosporins & Combos (Level 3)Broad Spectrum Penicillin (Level 1)

NATIONAL TEAMFOR THE ACCELERATION OF POVERTY REDUCTION

Sick

Treated