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HOSPITAL STRATEGY IN THE ERA OFUNIVERSAL HEALTH COVERAGE

Dr.dr.Sutoto,M.KesChairman of the Indonesian Hospital Association

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CORE DISCUSSION

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5 FIVE) INDICATIONS OFWHY INDONESIA WILL BE THE 7TH LARGESTECONOMY IN THE WORLD1. Stable economic growth and forecast

2. Growth in urbanization. 90% of the national economic growth

SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS

3. 11% of export is not from natural resources (oil and gas)

4. 7% decrease in labor intensive industries.

5. 60% of the economy is due to the increase in productivity

Resource: McKinsey Global Institute presentation by Chairman Raoul Oberman, Indonesias Vision for 2030 ,

Indonesias National Economic Committee, Ritz Carlton Hotel, 13/11/13

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G 20 MEMBERS

Ist: ECONOMIC LEVEL of INDONESIA IS ASSESSED ASMOST STABLE IN WORLD

90 % WORLD GDP 80 % totalWORLD COMMERCE

2/3 % WORLD POPULATION

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DEVELOPMENT Of ECONOMICS OfINDONESIA

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GROWTH OF URBANIZATION90% of the national economic growth is contributed by cities outside of Java

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60 % OF ECONOMIC GROWTH SUPPORTED BYINCREASE IN PRODUCTIVITY

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By 2030: 90 Million Indonesians could join theConsuming Class

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STAGES IN IMPROVING

QUALITY PERFORMANCE

Primitive: You should do X(X= Regulation, Standard, Incentive)

Medieval : You must do X

Modern: X is norm (X= Check list, Default, Feed back,Loops ex: CP)

Future : X is done (automation)

AtulGawande, MD, Plenary Speaker, ISQuaInternational Conference 14 Oct 2013. Edinburgh, Scotland

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THREE DIMENTION TOWARDUNIVERSAL HEALTH COVERAGE

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WHAT DO PEOPLE HAVE TO PAY OUT OF POCKET?

Around 150 million people suffer financial catastrophe eachear and 100 million ushed into overt because of out-of-

FIRST DIMENSION: FINANCIAL PROTECTION

What do people have to pay out of pocket ? Coverage mechanism VS cost sharing and fee ?

pocket health care bills (1)

Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems

Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services

PAYMENT SYSTEM : CAPITATION FOR PRIMARY CARE CASE BASE GROUP FOR SECONDARY AND TERTIARY CARE

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HOW CAN THE MIDDLE CLASS BENEFITFROM THE UNIVERSAL HEALTH CARE COVERAGE?

COST SHARING TO COVER THEIR DIFFERENT NEEDS

Patients that would like to stay in higher classes can pay thedifference with private health insurance

or out-of-pocket payment,Stated in Ministry of Health regulation PERPRES 12 TTG JAMINAN KESEHATAN. Clause 24

COVERAGE MECHANISM

(PAID BY BPJS)

COVERAGE MECHANISM

(PAID BY BPJS)

COST SHARING

COST SHARING

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SHIFT OF THE PATIENT AND THE ROLE OF HOSPITALSIN THE ERA OF UNIVERSAL HEALTH CARE COVERAGERS BLURS SNRS PT

RS BLURS SN

RS BLURS SNRS PT

PASIEN BPJS

PASIEN BPJS(100% coverage)

PASIEN BPJS(Additionalinsurancecoverage)

PASIEN BPJS(With option topay balance of

payment owing)

(Additional insurance

coverage)PASIEN BPJS(100% coverage)

IUR BIAYA(With option to paybalance of payment

owing)

TAHUN 2014

TAHUN 2019

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TEN LEADING SOURCES OF INEFFICIENCYTEN LEADING SOURCES OF INEFFICIENCY1. Medicine: underuse of generics and higher than necessary price.

2. Medicine: use of substandard and counterfeit medicines.

3. Medicine: inappropriate and ineffective use.

4. Products and services: overuse/ supply of equipment, diagnostic servicesand procedures.

5. Health workers: inappropriate or costly staff mix, unmotivated workers.

. ea servce: nappropr ae osp a a msson an eng o say.

7. Health service: inappropriate hospital size and low use of infrastructure.

8. Health service: medical errors and suboptimal quality.

9. Health system leakages: waste, corruption and fraud.

10. Health intervention: inefficient mix and inappropriate level.

Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems

Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services

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MANAGEMENT SKILL TO CONTROL PHYSICIAN

BEHAVIOUR

POSITIVE ADAPTATIONPROCESS FASTER

TO CONTROL

PHYSICIANBEHAVIOUR

NEGATIVEADAPTATION

PROCESS MORESLOW

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SIX STEPS HOSPITAL STRATEGY TOWARD UHC/JKN

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1.1. Develop: New Standards must be based on the nationalDevelop: New Standards must be based on the national

standards of hospital accreditationstandards of hospital accreditation

OVERALLHOSPITAL STRATEGY IN THE ERA OFUNIVERSAL HEALTH CARE COVERAGE

2.2. Use of : SPOs from the international adapted accreditationUse of : SPOs from the international adapted accreditationstandards,standards, formulariumformularium, Clinical pathways, checklists., Clinical pathways, checklists.

3.3. Train staff competence to execute: new accreditationTrain staff competence to execute: new accreditationstandards, use of checklists, clinicalstandards, use of checklists, clinical pathways,pathways, ICD 10 and ICDICD 10 and ICD

9 CM, INA CGBs and9 CM, INA CGBs and monitoring level ofmonitoring level of compliance withcompliance withreward program.reward program.

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