Issues of

Health Services

Henni Djuhaeni

Medical Faculty of

Padjadjaran University

HSMSession

4

Learning Objectives

At the end of this session, students are expected to:

explain the define of decentralization explain the Globalization and

decentralization of health care explain the Health care versus politic explain the MDGs Program explain Universal Coverage

Issues of Health Services

Health development

Decentralization

Millennium Development Goals (MDGs)

Human Development Index (HDI/ IPM)

Transfer of authority

Eradicate extreme poverty and hunger, Promote gender equality and empower women, Reduce child mortality, Improve maternal health, Combat HIV/AIDS, malaria and other diseases

Universal Coverage Health Finance System

1

2

3

4

National Health System

BACKGROUND

Maternal and child Mortality Rate

DEVELOPMENT CHALLENGES OF

HEALTH

Healthcare finance

The access of healthcare services

To achieve the target of Millennium Development Goals (MDGs)

To increase the roles of healthcare provider, policy maker, manager of healthcare services, insurance agency

competency

DecentralizationHealth PoliticHealth Policy

PEMBANGUNAN ?

Suatu proses perubahan yang berkesinambungan di segala bidang kehidupan yang dilakukan secara sengaja berdasarkan suatu rencana tertentu yang bertujuan untuk meningkatkan taraf hidup masyarakat, baik secara spiritual maupun material.

• RASIONAL• BERDASARKAN

FAKTA• ADA RENCANA• PROSES

TERKOORDINASI

• BERSIFAT POSITIF

• KEARAH YANG > BAIK

• PE STANDAR KEHIDUPAN

• PRODUKTIFITAS

• KEDUDUKAN, PERAN DAN KESEMPATAN YG SAMA

TOLOK UKUR

1

Health Development ?

HEALTH DEVELOPMENT

National Health System

Health status

Indicator: Life Expectancy, Maternal and Child Mortality Rate

- Potential measures nation -  to increase awareness, willingness and healthy life

INDEKS PEMBANGUNAN MANUSIA (HUMAN DEVELOPMENT INDEX)

Adalah sebuah ringkasan perhitungan dari perkembangan manusia.

Perhitungan ini merupakan rata-rata keberhasilan pencapaian sebuah negara ditinjau dari tiga dimensi (faktor): UHH, pengetahuan dan GDP perkapita.

HDI (INDEKS PEMBANGUNAN MANUSIA)

Long lived and healthy

Adult literacy index (score 2/3)Combined gross enrollment ratio (score 1/3)

life Expectancy (average life expectancy

in nation)

Education Index

Human development

measures

Ability to pay

GDP perkapita : bukan unlimited income , tetapi merupakan daftar logaritma dari pendapatan.

INDEX

GOALPOSTS

Tabel 2.1. Goalposts for HDI measures

Indicator Maximum value

Minimum value

Life Expectancy/ UHH (year)

Adult literacy Index (%)Combined gross enrollment ratio (%)GDP percapita (US $)

85

100

10040.000

25

0

0100

Sumber: Human Development Report 2005

HDI Measure

Actual value – minimum value

maximum value – minimum valueDEMENTION INDEX =

•Life Expectancy Index =

•Education Index =

Adult Literacy Index = =(ALI) =

Gross Enrollment Index = (GEI) =

• GDP =

Education sector- adult literacy index- Combined GE ratio

Economic sectorIncome percapita

Health sector :-LE-Maternal and child mortalitydouble

burden of diseases

Health finance problem

IPM

Health Development

National Health System

Decentralization of health

as the transfer of responsibility for planning, decision-making, the generation and the use of administrative resources and authority high government level to a lower level in a

hierarchical administrative political or territorial

2

Desentralization: Regional autonomy

Deconsentration of central governmentOfficials in region

Devolusion: Political influences

1. Bringing decision-making 2. Local specific development3. Potential community empowerment4. Health status increased5. Human Development Index (HDI) Indonesia increased6. Indonesia sehat 2025– “masyarakat mandiri untuk hidup sehat”

Healthcare finance

is sum of money

to purchase a range of

health care services and

products

is sum of money to production of

health care services

Healthcare provider Consumen

Government

Private

+

MDGs

Achieve universal primary education

Eradicate extreme poverty and hunger

Combat HIV/AIDS, malaria and other

diseases

Ensure environmental sustainability

Promote gender equality and empower women

Develop a global partnership for development

3

Reduce child mortality

Improve maternal health

Economy or Economic, what are you thinking about ?

How about the doctor and hospital ?

(greek = a household management / state)

OIKONOMEA

ECONOMY ECONOMICS

cost containment

efficiency

Is the science that deals with the cosequences of

resource scarcity

Health economic deals with the cosequences of resource scarcity in the

health care industry

Health care finance problems ?

No access to health care provider/ services

Health care finance problems

Cost of Heath services

Scarcity of the health budget

-Fee for services- supply induced demand-Administration fee increased

Community participation

OUT OF POCKET insurance

Universal Coverage 2014

Seluruh masyarakat dapat akses terhadap pelayanan kesehatan bermutu sesuai kebutuhan dasar dan kebutuhan medik tanpa membeda-bedakan tingkat penghasilan, status sosial dan tempat tinggal . Sumberdana dapat melalui pajak, asuransi dan dikelola dengan skema nasional atau beberapa skema yang berbeda.

Nitayarumphong & Mills

4

THE HEALTH CARE TRIANGLE

Third party insurer or purchaser

Citizen Provider(PPK)delivery

fund

ing

allocationEKSEKUTIF, LEGISLATIF,

BADAN INDEPENDEN

MONITORING

The provision and financing of health

care can be simplified as an

exchange or tranfer of resources

SUMBER PEMBIAYAAN

PEMERINTAH

- PEMERINTAH PUSAT

- PEMERINTAH DAERAH PROPINSI

- PEMERINTAH DAERAH KAB/ KOTA

SWASTA/ MASYARAKAT

- PERUSAHAAN/ PEMILIK

- ASURANSI KESEHATAN SWASTA

- PENGELUARAN RUMAH TANGGA

- SUMBANGAN SOSIAL

- COMMUNAL SELF-HELP- PAJAK SECARA UMUM

- PAJAK PENJUALAN

- BANTUAN / PINJAMAN LUAR NEGERI

- ASURANSI SOSIAL

KEBIJAKAN PEMERINTAH

?

UNDANG – UNDANG SISTEM JAMINAN SOSIAL NASIONAL (SJSN, 2004)

DILAKUKAN SECARA BERTAHAP DALAM KURUN WAKTU 30 TAHUN

ASKES SOSIAL ? Bukan gratis , tapi :

- Sifatnya wajib

- Premi : % pendapatan

- Yankes sama

- Bagi yg miskin , premi dibayar Pemerintah

SAKIT MISKIN

BESAR TUA

3 PILAR PEMBANGUNAN SISTEM JAMINAN SOSIAL NASIONAL

SOCIAL ASSISTANCE :Jamkesmas, jamkesda,

Jampersal, Bawaku Sehat

-Orang miskin -Tidak mampu-Penghasilan tidak tetap

Social insurance

Suplemen Insurance

-Compulsary -Seluruh penduduk berpenghasilan

-Jaminan >-Jaminan privat-Jaminan kesejahteraan

- Memenuhi kebutuhan dasar yg layak

- Need

Pemenuhan want, demand