presen hasbullah thabrany universal health coverage - case of indonesia and its problem solving (1)

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


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



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



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



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



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).


Framework for Problem Solving of JKN



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)




Detail and more

complete discussion

on UHC are here


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

presen hasbullah thabrany universal health coverage - case of indonesia and its problem solving (1)

Health & Medicine