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INDONESIA DEVELOPING HEALTHCARE MARKETS:
OPPORTUNITIES & CHALLENGES
dr. Santoso Soeroso, Sp. A
Dr. Ahyahudin Sodri, M.Sc. VDI
OUTLINE
1. About PERSI
2. Background
3. Data and Trend
4. Opportunities and Challanges
5. Conclussion
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 2
ABOUT PERSI
. PERSI (Perhimpunan Rumah Sakit Seluruh Indonesia/Indonesian Hospital Association) established in April 12, 1978
. PERSI has 32 provincial chapter (of 35 Province of the Republic of Indonesia}
. Total number of Hospital in Indonesia : 2.750
. Private Hospital : 1049
. Non profit Private Hospital : 695
. Government owned Hospital : 943
. State owned Enterprises Hospital : 63
. Total number of accredited Hospital : 1.096 (39.8%)
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 3
PENGUATAN SISTEM RUJUKAN
REGIONALIZATION OF REFERAL SYSTEM
RSU H Adam Malik
RSU Dr. M.Jamil
RSU Dr. Mohammad Hoesin
RSU Dr. Cipto Mangunkusumo
RSU Dr Hasan Sadikin RSU Dr. Soetomo
RSU Dr. Kariadi
RSUP Dr. Sarjito
RSUP Sanglah Denpasar
RSU Dr Sudarso PTK
RSUD H A WahabSjahranie
RSU Prof.Dr. R.D Kandou
RSU Dr W Sudirohusodo
RSU Jayapura
RSU Dr. Zainoel Abidin
RSUD Kep. Riau
RSUD Arifin Achmad
RSUD Raden Mattaher
RSU Dr. Ir. SoekarnoRSUD Dr. M. Yunus
RSU Dr. H. Abdul Moelok RSU Tangerang
RSUD Tarakan
RSUD Dr. Doris Sylvanus
RSUD Ulin
RSU Sorong
RSU Dr. Hasan BusorRSU Prof. Dr. Aloei
RSUD Mamuju RSU Kendari
RSU Dr. M Haulussy
RSU Prof. Dr. WZ JohanesRSUD Prov NTB
ClassNational
Province
H.Class A 12 2
H. Class B 2 15
H. Class C -- 3
Total 14 20
REGIONAL REFERAL
HOSPITAL : 110
H. Class A 2
H. Class B 59
H. Class C 45
H. Class D 4
**Kepmenkes HK.02.02/MENKES/390/2014 dan HK.02.02/MENKES/391/2014 NATIONAL REFERAL HOSPITAL
PROVINCE REFERAL HOSPITAL
4
MENTERI KESEHATANREPUBLIK INDONESIA
STRENGTHENING ACCESSIBILITY
1. BACKGROUND
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 5
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 6
Before the introduction of UHC in 2014,
Indonesia spent only 3.1% of its GDP
on health care in comparison to the
Philippines (4.4%) and Thailand
(4.6%).Source: World Bank and OECD
7
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 8
67% of Indonesian adult males are
cigarette smokers which is likely to be
a significant cause of lifestyle-related
diseases.Source: World Health Organization
Source: https://www.slideshare.net/JuliendeSalaberry/powering-the-future-of-healthcare-in-asia-etpl-iot-for-health-program-the-propell-group
2. DATA AND TRENDS
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 10
21.196Fasilitas Kesehatan Tingkat Pertama
(FKTP/HEALTH CENTERS/CLINICS)
2.230
Fasilitas Kesehatan Tingkat Lanjut (HOPITALS
AND SPECIALIST CLINICS)
1.007 OPTICS
2.342 PHARMACIES
379 LABORATORIES182.036.673
TOTAL MEMBER OF BPJS
NUMBER OF HEALTH FACILITIES SERVED THE JKN
27.154
Sumber: BPJS Kesehatan Per 1 Oktober 2017
PROVIDER OF THE NATIONAL HEALTH SECURITY SYSTEM (JKN)
Sumber: RS Online, Kementerian Kesehatan Republik Indonesia
33 33 33 33 33
96 98 113 120 129
455 463 469 480 501
92 93 98 97 96
3 8 8 13 16
118 127 125 125 126
41 42 42 42 44
724 737706 702 695
599
740
834
925
1.047
67 67 62 64 63
2013 2014 2015 2016 2017
KEMKES
PEMDA
PROVINSIPEMDA KAB
PEMDA KOTA
KEMENTERIANLAINTNI
POLRI
SWASTA NON
PROFITSWASTA
TOTAL
2.750
TOTAL
2.601
TOTAL
2.490
TOTAL
2.408TOTAL
2.228
(Data per 12 Okt 2017)
TOTAL NUMBER OF HOSPITAL IN INDONESIA2013 - 2017
GAMBARAN RUJUKAN PELAYANAN CATHLAB-JANTUNG
DISRIBUTION OF CATH LAB and CARDIOLOGICAL SERVICES, 2016
5
13
3
5 3
1 3
3532
211
136 2
0
53
1
3
1
2
6
4
11
19
11
5
4
5
8
3
38
221
110
40
25
126
19
7 2
4
4
4
1
11
19
4
2
9
1
2
Total of Cath Lab: 199 Cath Lab in 171 hospital Total cardiologist = 758 (2015) --> 850 in 2016
1
Radio therapy devices 48 unit (32 LINAC & 16 Cobalt)in 31 hospitaI n 18 cities, 14 ProvinceRatio 1 unit : 5,2 million POPULATION
RSU H Adam Malik
RSU Dr. M.Jamil
RSU Dr. Mohammad Hoesin
RSCM, RS Persahabatan, Dharmais
RSU Dr Hasan Sadikin
RSU Dr. Soetomo, RS RamelanRS Syaiful Anwar
RSU Dr. Kariadi
RSUP Dr. SarjitoRSUP Sanglah Denpasar
RSU Dr Sudarso PTK
RSUD H A WahabSjahranie
RSU Prof.Dr. R.D Kandou
RSU Dr W Sudirohusodo
RSU Jayapura
RSU Dr. Zainoel Abidin
RSUD Kep. Riau
RSUD Arifin Achmad
RSUD Raden MattaherRSU Dr. Ir. Soekarno
RSUD Dr. M. Yunus
RSU Dr. H. Abdul Moelok RSU Tangerang
RSUD Tarakan
RSUD Dr. Doris Sylvanus
RSUD Ulin
RSU SorongRSU Dr. Hasan Busor
RSU Prof. Dr. Aloei
RSUD Mamuju RSU Kendari
RSU Dr. M Haulussy
RSU Prof. Dr. WZ JohanesRSUD Prov NTB
X
X
X
xx
XX X
X
X
X
X
MRCC, RS Pusat Pertamina, RS Siloam Jakarta, RS Gading Pluit,
Rumah Sakit Rujukan Nasional
Rumah Sakit Rujukan Provinsi
Rumah Sakit Swasta
RS Memiliki Unit RadiotherapyX
X
X
XX
X
X
X
X
X
THE REFERAL SYSTEM OF RADIO THERAPY SERVICES
SEBARAN FASILITAS RADIOTERAPI
TOTAL NUMBER OF HOSPITAL AND SPECIALIST CLINIC PRIVATE HOSPITAL AND
SPECIALIST CLINIC : 47 %
HOSPITAL AND SPECIALIST CLINIC
INVOLVED IN JKN
2.412Sumber: BPJS Kesehatan Per 1 Oktober 2017
16
ANNUAL TREND OF UHC UTILIZATION (VISIT)
2014 2015 2016 2017
FKTP (Puskesmas/DokterPraktik Perorangan/KlinikPratama)
Poliklinik Rawat JalanRumah Sakit
Rawat Inap Rumah Sakit
Keterangan: Total Pemanfaatanadalah dalam kunjungan
66,8 Juta
100,6 Juta
134,9 Juta
21,3 Juta
39,8 Juta
50,4 Juta
4,2 Juta6,3 Juta
7,6 Juta
92,3 JUTA 146,7 JUTA 192,9 JUTA
Sumber: Laporan Bulanan BPJS Sampaidengan Bulan Juni 2017
106,2 JUTA
73 Juta
29,2 Juta
4 Juta
4. OPPORTUNITIES AND CHALLENGES
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 17
2015 2016 2017 2018 2019
Penduduk (Jiwa) 255 259 262 265 268
Peserta JKN (Jiwa) 136 156 211 231 258
PBI-KIS (Jiwa) 88 92 97 102 107
255 259 262 265 268
136 156
211 231
258
88 92 97
102107
00
50
100
150
200
250
300
PROJECTION OF TOTAL POPULATION, COVERAGE TARGET OF JKN & PBI-KIS 2015-
2019
Tahun%-Peserta
JKN
2015 60%
2016 70%
2017 80%
2018 90%
2019 95%
UNIVERSAL HEALTH COVERAGE
19
267 millionpeople will need to be insured in Indonesia by 2019, when
universal public healthcare is fully established.
USD 363 billionis the national healthcare expenditure expected to rise by
2025; a CAGR of more than 20% compared to 2010
(USD 20 billion).
The rising middle class is expected to drive demand for
affordable health care.
20
About a quarter billion Indonesians will demand quality
healthcare services, faster disease screening,
advanced medical technologies for early diagnosis,
and low cost, high quality efficacious medicines for
treatment
PROVINSI SULBAR
* 5 Provinsi dengan Rasio TT < 1:1000 penduduk (Jumlah Total TT di RS)
PROVINSI RIAU
PROVINSI LAMPUNG
PROVINSI JABARPROVINSI NTB
Demand for More Hospital Beds
Indonesia is expected to add about 40,000 beds by 2019 and JKN
would be a key driver; one of the early reports shows how the daily
patient volume in some of the provinces jumped up after JKN initiation.
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 22
1. Hospital development must be shifted to outside Java island. Is it economically profitable?
2. Bed capacity is almost saturated in Java, but there is still requitements in certain area in Sumatra, NTT-NTB, Kalimantan and Sulawesi Island.
3. Speciality services, such as cancer centre, cardiac centre, women & child centre (include NICU & PICU) will be required for new investment
Demand for More Hospital Beds
Including Paliative hospital
23
Demand for More Drugs (Generics)
As more patient get access to healthcare
through JKN, demand for prescription drugs
(generics) will grow; some companies have
already preempted this and increased their
production capacity to address the increased
demand.
Up to 50% of the revenues of a hospital can
come from sale of medicines to its patients.
Pressure on margin from UHC patients affects
manufacturers of generic drugs.
ACCORDING TO INTERNATIONAL DIABETES FOUNDATION (2015) , INDONESIA HAS 12 MILLION PEOPLE LIVING
WITH DIABETES (THE 5TH WORLD RANK)
BPJS Kesehatan data indicate that
In 2016, the use of insulin analogues was 99.5% compared to human insulin which was only 0.5%.
JKN spending for insulin – both human and analogues –increased in 2016, which was three times as high as in 2014. The spending was approximately IDR 1.1 billion (3,998 vials) for human insulin and IDR 243 billion (805,287 vials) for insulin analogues.
SYSTEMATIC REVIEWOF INSULIN ANALOGUE VS HUMAN INSULIN
Sabirin and Rahim ,et al. (2012) concluded that : insulin analogues compared with human insulin offer minor advantage in
controlling glycaemia reflected in HbA1c level, postprandial blood glucose
and fasting blood glucose, but they have advantages in reducing
occurrence of hypoglycemia, particularly nocturnal hypoglycemia and
severe hypoglycemia.
recommended that insulin analogues are used for type 1 diabetes and
type 2 diabetes who have recurrent hypoglycemia and not for gestational
diabetes.
there is need evidence for long-term safety and effectiveness of insulin
analogues.
MARKET ANOMALI
On one hand, it is surprising to see that lower-middle income countries such as Ghana list all types of analogue insulin given their limited healthcare resources. On the other, countries such as Germany with larger resources have purposefully rejected the general reimbursement of analogue insulin and allow it only in specific circumstances; general reimbursement is only allowed if their price is equal or lower than their human insulin counterparts .
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 28
Demand for More Medical Equipment and Demand for More Diagnostic Tests
Demand for medical devices is expected to
grow at much faster rate in the future as
compared with the
historical growth rate, especially for
consumables and imaging devices.
Domestic consumption of following
are expected to increase:
• X-ray films
• Consumables like gloves,
chemicals, catheters
• Computed tomography/magnetic
resonance imaging (CT/MRI)
equipment and consumable
associated with advanced imaging
procedures
INDONESIAN RENAL REGISTRY 2016
INDONESIAN RENAL REGISTRY , HEMODIALYSIS
T
32
Demand for Qualified and Skilled Healthcare Professionals
The already scarce medical professionals (doctors and
paramedical staff), which are way below the global
and Organisation for Economic Co-operation and
Development (OECD) averages, will be put under
pressure by the burden of the increasing number of
JKN patients.
investors need to recruit and retain good doctors, in
particular, specialists who play an important role in
upholding the standard of care and reputation of a
hospital, which are ultimately profit-drivers in the
business.
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 33
Telehealth Services
Medical device companies will adopt
collaborative business models to penetrate
the rural markets with remote patient
monitoring and tele-health devices that can
improve patient access and increase the
awareness and reach of their products
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 34
1. First-level outpatient services covered under JKN: Simple
laboratorium diagnostic tests (blood tests, urine tests, stool
tests, and blood glucose tests)
2. Market segments:
o Immunochemistry testing
o Microbiology testing
o Molecular diagnostics testing (high growth area)
• Virology
• Bacteriology
• Molecular blood donor screening
• Genetic testing
InVitro Diagnostics Market
The origin of Medical Tourist McKInsey Quaterly, 2008
• 93% Asia population flight to
other Asia countries for medical
services
• Potential of Medical Tourism Asia
in 2013, US$ 8.5 billion (Global
Information Inc., 2012)
• Potential of Medical Tourism
Global mencapai US$ 100
billion with growth of 20%-
30% (McKinsey & Co., 2012)
THE OPPORTUNITIES FOR
MEDICAL TOURISM IN
INDONESIA
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 36
The new Indonesian Government has recently introduced a new
“one-stop-shop” to make it easier to start a business. However,
opening and
operating new hospitals and clinics without a local partner remains
a challenge in Indonesia.
Second-tier cities, such as Palembang or Batam, with comparably
low bed-to-population ratios, provide good opportunities for
investments
Though a majority of publicly-listed hospital players have reported EBITDA margin
of up to 33% (EBITDA to net revenue margin) in the last five years, hospital
operators still need to maintain a strong hold on cost and capital.
Foreigners are restricted from ownership in general hospitals. The upper
middle class (as a % o f total population) has risen significantly from
0.3% in 2003 to 1.5% in 2010. However, high-end private specialized
health care remains a niche market in Indonesia and competes with
medical tourism to other ASEAN countries.
DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 37
The recent introduction of Indonesian
Government supported Universal Health
Coverage (UHC) for all citizens and
residents provides opportunities for
investors to develop the health care
sector.