strengthening ,qgrqhvld·v health system through the national … prof. dr. dr. fachmi idris... ·...
TRANSCRIPT
Prof. Dr. dr. Fachmi Idris, MKes
President Director
1st Sriwijaya University International Conference on Public Health:
Public Health Responses to Health Systems Strengthening
Palembang, 5 Oktober 2017
Strengthening Indonesia’s
Health System through the
National Health Security
1
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I. INTRODUCTION
II. STRENGTHENING HEALTH SYSTEM THROUGH THE
IMPLEMENTATION OF NATIONAL HEALTH INSURANCE
III. CHALLENGES
Topics
INTRODUCTION
HEALTH SYSTEM
World Health Report 2000:
Health System (Gro Harlem Burtland)
Leadership/Governance
Health Care Financing
Health Workforce
Medical Products, Technologies
Information Research
Service Delivery
System Building Blocks (6 blocks)
Presidential Decree 72/2012:
National Health System
Research and Development on
Health
Health Financing
Health Workforce
Pharmaceutical, medical devices and food supply
Management, Information and Regulation on Health
Community Empowerment
Subsystems of National Health System (7 blocks)
Health Effort on Personal and
Community
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HEALTH SYSTEMS PERFORMANCE
FRAMEWORK (WHO 2000)
Stewardship
Financing
Creating Resources
(Investment &
Training)
Delivering
Services
Responsiveness
people’s expectation)
Fair Financial
Contribution
Health
(collecting,
Pooling and
Purchasing) – 6
sub systems of
financing
National Health Insurance
5
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3,5 Years of
JKN-KIS
2014 - June 2017
Health Financing
Pharmaceutical Medical
Devices and Food Supply
Health Workforce
Community Empowerment
Information management Regulation on Health
Research and Development
Health Effort on Personal
and Community
National Health System
Presidential Decree No 72/2012
Sustainibility :
• Affordability
• Acceptability
• Adaptability
Strengthening
Sustainability
Stimulating
Success
Success* :
• Healthy community
• Superior healthcare
• Fairness
*Fineberg V. F. (2012)
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The progress towards universal
health coverage
0
20
40
60
80
100
120
140
127 yrs
118 yrs
79 yrs 72 yrs
48 yrs
36 yrs
26 yrs 8
5%
Po
p (
80
,6 m
ill.
)
10
0 %
Po
p (
11
,4 m
ill.
)
99
% P
op
(8,7
mil
l.)
10
0 %
Po
p
(58
2,2
91
)
87
% P
op
(4,8
Jt )
10
0 %
Po
p
(12
6,7
Jt )
97
,2 %
Po
p
(50
,9 J
t )
Germany Belgium Austria Luxemburg Costa Rica Japan South Korea
UHC: International comparison 3,5 years
towards
UHC
2014-
2019
2016
133.423.653
156.790.287
180.498.482
171.939.254
1st semester
(18 August 2017)
> 70% of
the population
2014 2015
Source: LPP Jamsoskes
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JKN’s effect on National Health System
• Health
– Life expectancy rate in Indonesia is increasing (OECD 2016)
• Responsiveness
– JKN is effective in improving health equity for poor and near poor community (PRAKARSA, 2017)
– Costumer satisfaction index of JKN Participants is 78,6% (BPJS Kesehatan, 2017)
• Fair Financial Contribution
– With the new JKN scheme, the level of OOP spending among the insured population is decreasing (WHO, 2017)
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STRENGTHENING HEALTH SYSTEM THROUGH
THE IMPLEMENTATION OF NATIONAL HEALTH
INSURANCE
10
Key Function of Health Care System
Tertiary Hospital
Secondary Hospital
Primary Care with
Inpatient
Gatekeeper Primary
Care
Individual/
family
1. Arrangement of provider distribution
capacity planning 2. Gatekeeper
3. Healthcare Standard (human
resource,
facilities, guidelines)
4. Regulation
5. Reverse referral system (referral
from secondary to primary care for
chronic disease patients in stable
condition)
6. Sufficient incentives
7. Continuous, accurate and real
time information system
8. Standardized administration
9. Emergency management
service 10. Monitoring and evaluating
11. Continuous communication with
healthcare providers and
beneficiaries
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Source: Adapted from Ministry of Health Decree No. 01/2012
and 71/2013 By Deputy of Primary Financing Insurance
Health care benefit
Focus on individual health rather than public health Health promotion, disease prevention, curative, rehabilitative, drug &
medical devices based on medical indication using referral system
Medical
Non medical
Primary care
Ambulance
Inpatient accommodation
Supplement (spectacles)
Promotive & preventive: 1.Individual health counseling 2.Screening (diabetes, hypertension,
cervical cancer) 3.Immunization (basic and advance) 4.Family planning
Curative & rehabilitative 1. Outpatient 2. Inpatient 3. Obstetric 4. Emergency care
Vaccine, contraception provided by government
Secondary care
11
12
2014 Audited Report by Dec
2015 Audited Report by Dec
66,8
million
21,3
million
PHC
Outpatient
Inpatient
4,2
million
100,6
million
39,8
million
6,3
million
133,4
million
Total Cost: 42 T Total Cost: 57 T Total Cost: 69 T
156,79
million 2016 Audited Report by Dec
171,9
million
134,9
million
50,4
million
7,6
million
Healthcare Utilization 2014-2016 Improving Access and Degree of Health
PHC
Outpatient
Inpatient
PHC
Outpatient
Inpatient
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13
2017 1st Semester
Health Utilization and Catastrophic Care per 1st Semester 2017
72,8
million
29,2
million
4,02
million
178,3
million
Data source : LPP Jamsoskes
DIRECT CONTRIBUTION: Enhance health recovery and prevent
disablement through health promotion and disease prevention
source : Data BOA, per June 2017 (loading month)
Protect community
from poverty and
the poor from
catastrophic health
expenditure Improve the productivity of the community
both socially & economically
PHC
Outpatient
Inpatient
2014 2015 2016
Cost of catastrophic diseases*
* Cardiovascular, cancer, kidney failure, stroke, thalassemia, cirrhosis Hepatic, leukaemia, haemophilia
** Percentage from total hospital costs
• 7 million cases
• 10,6 trillion
IDR
37,32 %**
• 10,3 million cases
• 13,9 trillion
IDR
32,41 %**
• 9,8 million cases
• 12,7 trilllion
IDR
24,81 %**
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Healthcare Facilities: more than 50% private
hospitals accepted referrals
78,8%*
Data source : LPP Jamsoskes *of registered hospital
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Healthcare Cost 2014-2016
168 T Primary and Secondary
Repeated outpatient increasing (Q-5-44-0)
• 19.7 mil cases (2014) → 34.4 mil
cases (2016)
• Cost: 3.7 T 4 →6. T (2016)
Triple Burden Of Diseases
• Infectious Diseases
• Chronic Diseases
• Mental Disease
Healthcare Cost
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21,62% 20,34% 19,65%
78,38% 79,66% 80,35%
10%
0%
20%
70%
60%
50%
40%
30%
80%
90%
Trend of Healthcare Cost Ratio 2014-2016
Secondary care
Primary care
2014 2015 2016
There is a decreasing trend of cost ratio for primary care compared to secondary care from
2014 to 2016
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Access to high quality
PHC
Optimum Reverse Referral System
Peer Review Per
PHC
Health promotion & disease
prevention
Pay for Performance
& Walk Through
Audit
Strengthening Primary care function
• Credentialing/
Recredentialing
• Support from
related parties
• Simple
administration
• Sufficient drug
supplies
• Presence of
pharmacy
• Therapy
Management
• CME
• Planning
• Outonomy (BLUD)
• PROLANIS
revitalisation &
development
• Early detection
• Monev
• Implementation
Research
• Campaign
• Monitoring and
Evaluating
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Health promotion & disease prevention strategy
Prevent
complication
Disease
management
BPJS members
Healthy Risky Sick
Prevent from
being sick
Maintain/
promote
Health promotion & disease prevention programs
Good quality of life
Sustained JKN
Important role of primary care doctors in implementing health
promotion & disease prevention programs 18
19
CHALLENGES
Challanges
Healthcare facilities
supply 1
Cost containment 2
Referral system 3
Need improved understanding about INA
CBGs payment system
• The growth of healthcare facilities is lower
than the growth of participants
• Uneven healthcare facilities distribution
Most people are specialist and hospital-
minded, reluctant to visit primary care
facilities as their first contact
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Challenges (2)
Adverse Selection 4
The behavior where
people seek health
insurance when they
need healthcare
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EFFORTS TO IMPROVE NATIONAL HEALTH SECURITY
BPJS Kesehatan Care Center 1500-400
1. Information
2. Complaint handling
3. Teleconsulting
Web-based application BPJS
Kesehatan
1. Healthcare facilities location
2. Healthcare facilities registered as BPJS
Kesehatan provider
3. Real-time online referral system to
hospitals
Improving Services
1. Bridge Information System between
healthcare facilities and BPJS Kesehatan
2. Developing Coordination of Benefit (COB)
3. No cost sharing
4. Reverse referral system optimization
5. Health promotion & disease prevention
programs:
- Prolanis
- IVA Papsmear
- Health screening through Mobile JKN
- Exercises
6. HFIS application to simplify provider
registration process
Mobile JKN Virtual Office
1. Registration
2. Contribution payment status
3. Medical history check
4. Healthcare facilities location
5. Change participant data
Ease of registration access
1. Drop Box system in BPJS branch office
2. Registration in banks and malls
3. Mobile JKN and BPJS Kesehatan
website
4. BPJS Kesehatan Care Center 1 500 400
5. Mobile Customer Service
6. Drop Box on sub district office
7. BPTSP (one-roof registration)
8. Kader JKN (door-to-door agents)
9. E-Dabu (web-based registration for
business entities)
Ease of payment access
1. ATM
2. Traditional and modern PPOB
(minimarket, online shop)
3. SMS Banking, Internet Banking
4. PT. POS Indonesia
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CONCLUSION
The JKN program is one of the government's efforts to strengthen the health system in Indonesia. For 3.5 years BPJS Health operates, has reached more than 180 million people so that they are protected both access and financial.
Many things that must be done to maintain the continuity of this program, ranging from revisions of laws and regulations that can synergize positively to build programs, alternative sources of financing and benefit packages. Support from various parties is also needed, one of them is related to the distribution of health facilities to improve access.
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