IMPROVING FINANCIAL RISK PROTECTION: ISA RACHMATARWATA MINISTRY OF FINANCE

Transcription

1 IMPROVING FINANCIAL RISK PROTECTION: THE EXPERIENCE OF INDONESIA ISA RACHMATARWATA MINISTRY OF FINANCE

2 Indonesia Area size 1,913,578,68 Districts 399 Municipalities 98 Sub-districts Villages Sub-villages 72,944 Outside of Java 42.5% Area Size 93,2% Java 57.5% Area size 6.8% GDP: USD 3500 per capita Total Health Expenditure: IDR 215 T, 3.1% of GDP Health expenditure per capita: USD ,5% - public spending 61,4% - private spending Uninsured population:28%

3 Health Financing Programs Before and after 2014 Before 4 national programs: 3 by segment of labor and 1 for the poor Many regional programs with different scope of participation Some relied solely on commercial indemnity insurance No portability Some contributory, some non contributory Various benefit coverage After 1 mandatory basic program for all people in all regions Uniform medical benefit 3 classes of non-medical services for inpatient Contributory with several contribution scheme; the poor is paid by the Govt Portability applies

4 What has the new program accomplished?

5 Participation in the Program % 70.00% 61.37% 72.93% % 50.00% 40.00% 47.02% 52.91% % (est) Tenured workers Non-tenured workers Supported by Govt. Total 20.00% 10.00% 0.00% (est) Source: BPJS Kesehatan and BPS

6 People accessed services more Percentage of population took outpatient services in the last 1 month Percentage of population took inpatient services in the last 1 year Source: BPS

7 yet pay less from their pocket Percentage of OOP to THE Percentage of PvHE to THE Source: NHA Ministry of Health

8 and got treatment for chronic diseases Diagnosis Hepatitis cirrhosis Chronic kidney diseases Haemophilia Heart diseases Cancer Leukemia Stroke Thalassemia Subtotal Total claims Source: BPJS Kesehatan (up to Q3) Cases Costs (Rp) Cases Costs (Rp) 98, ,873,526,239 73, ,839,943,013 1,406,441 2,257,121,854,482 1,211,179 1,665,106,189,916 18,932 65,777,150,032 14,394 52,471,087,168 4,891,165 8,189,617,320,553 3,955,990 5,462,622,606, ,487 2,051,837,156, ,636 1,318,441,762,400 41, ,576,498,009 33,325 94,901,820, ,367 1,051,184,069, , ,712,834,510 80, ,940,028,726 57, ,746,656,027 14,318,927,604,128 9,658,842,899,563 42,658,702,022,638 41,412,899,624,930

9 What has the Government done to start and maintain the program?

10 Increase health expenditures % % 4% 3% % % Education Infrastructure Health Food security Energy Subsidy Government Expenditure on Health (Rp trillion) (LHS) Health budget allocation (RHS) 0% Sorce: Ministry of Finance

11 Contributes to JKN Government contributions to JKN was IDR trillion in 2014 and IDR trillion in 2015 Include subsidy for the poor of the amount IDR 16.61trillion (2014) and trillion (2015) In addition, the Government injected IDR 5 trillion in 2015 to partially close the deficit Some regional governments also contributed to JKN: IDR 1.35 trillion in 2014 and IDR 2.36 trillion in 2015 As a comparison, the total private sector contributions to JKN in 2014 was IDR 7.10 trillion and IDR trillion in 2015 Include contributions by non-tenured workers of the amount IDR 4.56 trillion (2014) and IDR 7.57 trillion (2015)

12 Contributes for the poor Budget allocation (IDR tril, LHS) Targets (mil people, RHS) Account gontributions only by central Govt.

13 What are our challenges?

14 Physically

15 From technical perspective 120% 118% 116% 114% 112% 118% Claim Ratio 114% 110% 108% 106% 106% 104% 102% 100% 98% (proj)

16 From socioeconomic perspective High proportion of informal economy Low tax coverage Many basic needs competing for limited fiscal space Drift from traditional benevolent community

17 What do we have to do to make better achievement?

18 HEALTHY INDONESIA PROGRAMME MOH STRATEGIC PLAN HEALTHY PARADIGM Health mainstreaming in the development Promotive Preventive as main pilars in health programmes Community Empowerment HEALTHCARE STRENGTHENING Improving access, particularly at primary level Referral system optimization Quality improvement Continuum of care throughout the life cycle Health risk based intervention NATIONAL HEALTH INSURANCE (JKN) Benefits Financing system: insurance gotong royong principle Quality Control & Cost Control Objects: Support Recipient and Non Support Recipient Source: Ministry of Health

19 From macro perspective To maintain inclusive growth in the economy To perform prudent fiscal management To expand fiscal space to allocate more for health To encourage healthy lifestyle

20 THANK YOU..