RESTRUCTURISATION OF JKNMid Term Program

(2019-2024)

Jakarta, 2 November 2018

Achievement of JKN

MEMBERSHIP: 200+ MILLION PEOPLE

People with chronic, degenerative, and catastrophic diseases

Health Services Structurisation & Standardisation

Cost Control & Quality Control of Health Services

Functional integration of government and private health services

INDIRECT IMPACT:

• Structuring and Strengthening the Domestic Health Market

• Population administration via the single identity number

29 Oktober 2018 RESTRUKTURISASI JKN 2

Structural Deficit

-3,309.11

-8,371.14

-6,319.46

-18,199.73

-20,000.00

-18,000.00

-16,000.00

-14,000.00

-12,000.00

-10,000.00

-8,000.00

-6,000.00

-4,000.00

-2,000.00

0.00

2014 2015 2016 2017

Surplus (Defisit) Tahun Berjalan • Compared to 2015, the 2016 deficit declined due to an increase in contributions;

• In 2017 there is an increase in DEFISIT ALMOST 3X FOLD from 2016;

• A very significant and prolonged deficit indicates that STRUCTURAL DEFISIT has occurred;

• Structural deficits can not overcome by efficiency, but a comprehensive RESTRUCTURISATION is needed, both INA CBG rates, premium, service systems, etc

RESTRUKTURISASI JKN 3

JKN PROBLEMS

10/29/2018 RESTRUKTURISASI JKN 4

KURANG DANA DEFISIT STRUKTURAL

• IMPRUDENT POLICY:• PROBLEM IN HEALTH SERVICES TARIFF:• IMPACT OF SYSTEMIC DISORDERS:

PEMANFAATAN DATA & TEKNOLOGI INFORMASI TERBATAS

ADVERSE SELECTION

EXPECTATIONS ARE UNLIMITED

LOW PREMIUM PAYMENT DISCIPLINE

WEAK COMPLIANCE MONITORING

INEFFECTIVE IN PREVENTING ADVERSE SELECTION

.

TATA KELOLA MENYIMPANG DAN SARAT KONFLIK KEPENTINGAN• SUPERVISION BY MANY INSTITUTIONS BUT

FRAGMENTATIVE AND INEFFECTIVE

• BPJS HAS NOT YET ACTED AS AN ACTIVE PURCHASER

• DJSN HAS NOT FUNCTIONED PROPERLY

PARTISIPASI PUBLIK RENDAH DAN

PBPU CONTRIBUTION COLLECTION HAS NOT YET

AUTODEBIT

MANUAL DRUG PLANNING WITH RKO, HAS NOT USED

CLAIM DATA (BIG DATA)

THE DETAILED CLAIMS AND CAPITATION DATA ARE NOT

UTILIZED IN CALCULATING CONTRIBUTIONS,

BENEFITS, AND POLICIES.

LACK OF FUNDS STRUCTURAL DEFICIT GOVERNANCE AND CONFLICT OF INTEREST

LOW PUBLIC PARTICIPATION & EGOSENTRICUSE OF DATA & LIMITED INFORMATION

TECHNOLOGY

5. DATA & IT

PARTISIPASI PUBLIK & PEMBUDAYAAN JKN

4. GOVERNANCE

1. BENEFIT,2. PREMIUN

3. TARIFF

6. MANDATORY PARTICIPATION & JKN

CULTURE

BASIC COMPREHENSIVE SOLUTION: Restructrurisation of JKN Regulation

Benefits & contributions in accordance with actuarial calculations, costs sharing to prevent over-utilization and fraud, government reserve funds and promotive, preventivestrenghthening.

Tariffs are in accordance with economic prices with quality assurance and service security in accordance with national service standards and national health facilities standards.

Checks & balances: DJSn – BPJS Health position

Automation of administration, monitoring and evaluation

Utilization of data and information for policy making

communication, education, information and enculturation Law enforcement UHC

RESTRUKTURISASI JKN 5

6 AREAS OF JKN RESTRUCTURING

SET THE BENEFITS OF JKN

INCREASE JKN PREMIUM

LIST THE HIGHEST HEALTH SERVICES TARIFF BASED ON ECONOMIC VALUE

IMPROVING DJSN-BPJS KES GOVERNANCE

USE OF DATA & INFORMATION TECHNOLOGY

MANDATORY PARTICIPATION AND LAW ENFORCEMENT

2 November 2018 RESTRUKTURISASI JKN 6

1

2

3

4

5

6

10/29/2018

RESTRUKTURISASI JKN 7