Download - Presen hasbullah thabrany universal health coverage - case of indonesia and its problem solving (1)
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Universitas Indonesia, Center for Health Economics and Policy Studies
Universal Health Coverage: Case of Indonesia and Its Problem Solving
Hasbullah ThabranyChair, CHEPS UI
Email: [email protected]
8/5/2016 Hasbullah Thabrany - CHEPS UI 1
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Universitas Indonesia, Center for Health Economics and Policy Studies
Main Characteristics of the Ina-Medicare, UHC Indonesia
• A single payer system, JKN, for all Indonesian citizens (including foreigners). Currently, it covers 165 million people registered in BPJS Kesehatan (the Corporation of NHI)
• Comprehensive benefits (A-Z health care) of the most-cost effective are delivered through public and private health care facilities contracted with BPJS Kesehatan
• To ensure efficiency, the UHC uses prospective payments to all contracted providers.
• A Commission of Health Technology Assessment (InaHTAC) is established to appraise benefits
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Universitas Indonesia, Center for Health Economics and Policy Studies
The Strengths of the JKN (UHC)
• As a single payer, JKN has monopsony power. It promote efficiency and massive health reform
• At this time, the medical professionals and hospitals’ economic power are not strong enough, so—it shapes the health care system
• There is still strong culture to follow the Government policy, although the providers are unhappy, it moves relatively smooth.
• People are not strong enough to reject short term deficiencies in health care. Resistancy is weak
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Universitas Indonesia, Center for Health Economics and Policy Studies
The Challenges
• So many doctors and hospital managers complained about inappropriate prices of capitation and INA-CBGs.
• Even doctors in public hospitals complained the CBG prices. What is fair and unfair prices?
• Generally large private hospitals have yet to sign contract with BPJS due to unattractive prices
• Many public and private hospitals are pushed to CHEAT (moral hazard to fraud) to meet their EXPECTED surpluses or to reduce DEFISITS
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Universitas Indonesia, Center for Health Economics and Policy Studies
The Main Problems of JKN
• Contributions and revenues have been inadequate to purchase good quality of care, especially in private providers
• Procedures and decision process in setting contributions and prices are not transparent
• Decision makers have not (yet) practicing evidence base policy
• Providers have not reacting fairly on capitation and GBG prices. Instead they shift the costs to patients
• Employees and employers of large companies are complaining of poor quality of JKN and long queues
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Universitas Indonesia, Center for Health Economics and Policy Studies
Example of equity: A study by GIZ on Out of pocket of expenditures among JKN members 2015
8/5/2016 Hasbullah Thabrany - CHEPS UI
Outpatient inpatient
The OOP spending compared to household income shows a much higher burden for the poor. (% OOP to the proxy income).
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Universitas Indonesia, Center for Health Economics and Policy Studies
Framework for Problem Solving of JKN
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Universitas Indonesia, Center for Health Economics and Policy Studies
Actions Needed to Correct
• Large and thorough cost study and analyses, based on average market costs, to meet fairness in payments.
• Increase payments to, especially, private providers
• Improve quality of care and reduce queues by contracting more private providers
• Surveys on evidences and the scale of out of pockets payments due to cost shifting by providers
• Surveys on crowded out members, who do not use the benefits
• Surveys on other barriers (distant, inadequate supplies, and other non financial bariers)
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Universitas Indonesia, Center for Health Economics and Policy Studies
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Detail and more
complete discussion
on UHC are here
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Universitas Indonesia, Center for Health Economics and Policy Studies
The Borobudur temple, built in the 9th century, was
constructed for long time, but it last long!!!
the INA-Medicare will do8/5/2016 Hasbullah Thabrany - CHEPS UI 16