Challenges and Opportunities for Future Challenges and Opportunities for Future Public SpendingPublic Spending

Investing in Indonesia’s Investing in Indonesia’s HealthHealth

Health Public Expenditure Review 2008

Indonesia’s Health Indonesia’s Health System and Financing System and Financing

ChallengesChallenges

Indonesians are living longer and Indonesians are living longer and child mortality has fallen child mortality has fallen dramaticallydramatically

Indonesia’s Health System Health System ChallengesChallenges Stagnating Health OutcomesStagnating Health Outcomes Geographic InequalitiesGeographic Inequalities Under-funding Under-funding Inefficiencies (low utilization)Inefficiencies (low utilization) Financially UnsustainableFinancially Unsustainable Limited Health Insurance CoverageLimited Health Insurance Coverage Weak StewardshipWeak Stewardship

Particular challenges remain in Particular challenges remain in MDG related areasMDG related areas Maternal mortalityMaternal mortality Child malnutritionChild malnutrition Female literacy and access to clean Female literacy and access to clean

waterwater Geographical disparitiesGeographical disparities

Demographic transformation will Demographic transformation will demand a different, more expensive, demand a different, more expensive, health care systemhealth care system

Indonesia 1970 Indonesia 2025

Indonesia’s Health Financing Challenges

Ensuring Adequate Fiscal SpaceEnsuring Adequate Fiscal Space Ensuring Adequate & Equitable Ensuring Adequate & Equitable

FinancingFinancing Improving Efficiency in Provider Improving Efficiency in Provider

Payment SystemsPayment Systems Enrolling Informal Sector WorkersEnrolling Informal Sector Workers Defining Basic Benefit PackageDefining Basic Benefit Package Developing Data for Decision Making Developing Data for Decision Making

(DDM)(DDM)

9 Ideas for Better Health Outcomes 9 Ideas for Better Health Outcomes in Indonesiain Indonesia

Policy Policy OptionsOptions::

1. Make better use of existing resources, while 1. Make better use of existing resources, while also making more resources available in the also making more resources available in the medium termmedium term

2. Increase spending on maternal 2. Increase spending on maternal healthhealth

Allocate more resources for referral and Allocate more resources for referral and institutional deliveriesinstitutional deliveries

3. Improve resource allocation for 3. Improve resource allocation for preventive care & allow sufficient preventive care & allow sufficient resources for O&Mresources for O&M

4. Devote additional resources and 4. Devote additional resources and attention to all major public goods that attention to all major public goods that determine health outcomesdetermine health outcomesMillennium Development Goals Households/Communities Health Sector and

Related SectorGovernment Policies and

Actions

Health

- Underweight- Under-five

mortality ratio - Maternal

mortality ratio- Communicable

diseases

Household actions and risk

factors

- Use of Health service

- Dietary, sanitary and sexual practices- Lifestyle

Household Assets

- Human - Physical- Financial

Community Factors- Cultural norms

- Community institutions- Social capital- Enviroment

Other MDG outcomes

- Poverty

Health providers- Private: for-profit nonprofit- Public hospitals, primary care, informal

Finance and Inputs

- Public and private insurance; financing and coverage- Drugs

- Health sector policies at macro, health system and micro levels

- Government spending

Other policies - Infrastructure- Transport- Energy- Agriculture- Water and sanitation

Supplies in related sectors

- Food - Energy- Roads- Water and Sanitation

5. Adjust DAU to provide incentives for 5. Adjust DAU to provide incentives for local civil service reform and amend PP local civil service reform and amend PP No. 55 to allow operational use of the No. 55 to allow operational use of the DAKDAK

6. Increase coverage of the Askeskin 6. Increase coverage of the Askeskin ProgramProgram

7. Ensure financial sustainability of 7. Ensure financial sustainability of Askeskin by introducing cost-Askeskin by introducing cost-containment optionscontainment options

8. Increase efficiency by including 8. Increase efficiency by including private providers in insurance private providers in insurance schemesschemes

9. Improve reporting and budgeting 9. Improve reporting and budgeting systems as well as data availability systems as well as data availability and transparencyand transparency

Thank You