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ali gufron
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PROGRESS AND CHALLENGES TO ACHIEVE PROGRESS AND CHALLENGES TO ACHIEVE UNIVERSAL COVERAGE
IN INDONESIA
Prof. dr. Ali Ghufron Mukti, MSc., PhD.Vice Ministry of Health Republic of Indonesia.
Presented inPMAC BANGKOK 24 28 JANUARY 2012PMAC , BANGKOK 24-28 JANUARY 2012
Policy Objectives:
January 2014 almost all Indonesians are covered under
Policy Objectives:
January 2014, almost all Indonesians are covered under one office of Health Insurance Carrier with integrated
t f th i ti hmanagement of the existing schemes.
VARIOUSHEALTHINSURANCESCHEMESININDONESIA
YearSchemes Target Coverage
1969PTAskes CivilServant 15.500.000PT
1992PTJamsostek FormalSector 5.500.000
PoorandNear 385%In2005Jamkesmas Poor 76.400.000 patient
2003JamkesdaLocalGovInitiative 31.800.000
1992Commercial/
TheRich/bigCompanies 10.700.000
S lf i d T t l 139 900 000Selfinsured Total 139.900.000
Two Carriers Established (Social Security Carriers Law/ Two Carriers Established (Social Security Carrier s Law/ Law 24/2011, Law on Social Security (No 40/2004))
Health Insurance Carrier (BPJS Kesehatan):M i l h lth i Manage social health insurance program Started on 1 January 2014
Workmans Carrier (BPJS Ketenaga-kerjaan)( g j )Manage; Accident Benefit, life Insurance, Pension, Aged benefitbenefit, Started on 1 July 2015
4
TNI/
Scenario of Integration From Existing ManagementINFORMAL TNI/ POLRI
JKEMJAMKESMAS HEALTH LIFE WORK
INFORMAL
JkesMas+
JAMKES +
As
YKES
YKESJkes PRO
JKK +
JKEM+
JHT+
JKK+
SKem+
NON PROGRAM
JAMKESMAS(For the Poor) PROGRAM
WORK ACCIDENT
INSURANCE
OLD AGE
ACCIDENT
LIFE INSURANCE
HEA
AsKes+
S+S+
Jkes PRO
JHT+
JKesDa + JHT +
JKem +
JHT+
JPen+ Jpen+
NON PROGRAM
JAMKESDA
LIFE INSURANCE
OLD AGE
OLD AGE
PENSION
OLD AGE
PENSION
L TH
BPJS 1(Carrier 1)
BPJS 2(Carrier 2)
JKesDa + JHT + JPen+ Jpen+(Local Initiative)(Local Initiative)
OLD AGE PENSION PENSION
( ) (Carrier 2)
5FASE IIPHASE I PHASE IIPHASE II
ChallengesIndonesianIndonesia Archipelago:
Challenges
- Number of Island :17,508 E t t W t Di t 5 120 K- East to West Distance 5,120 Km(London Moscow)N th t S th Di t 1 760 KNorth to South Distance 1,760 Km
- Population 237 Million
Conceptual pFramework
Equity and
Existing Situation:1. Disintegrated
implementation and coverage
Strategy:1. Synchronisation &
integration of schemes2 Improve fund pooling
Challenges:116 activities:1. Membership
and Quality
Achieved
coverage2. Fragmented fund
pooling & management3. Limited & variations of
b fit h
2. Improve fund pooling3. Optimising benefit
package among schemes
4 Development and
MIS2. Provision of
service (114 000 benefit among schemes
4. Variations of carriers management
5. Lack of monitoring,
4. Development and improvement of carriers
5. Strengthen coordination
(114,000 Beds) & benefit package
3 Fi i (
Expected Health
Insurance Coverage
ExistingHealth
InsuranceCoverage
g,evaluation and coordination among schemes
coordination, monitoring & evaluation
3. Financing(employee)
4. Organisation and
NSSC runing well
management of carriers
7