Upload
hendranto-nugroho
View
217
Download
0
Embed Size (px)
Citation preview
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 1/19
H Thabrany/ISS UI 1
Politics of National Health Insuranceof Indonesia: A New Era of
Universal Coverage
Hasbullah Thabrany
Institute for Social Security,
University of Indonesia
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 2/19
H Thabrany/ISS UI 2
Conditions of 2004
• Government financing mainly trhough supply sidesubsidy: inappropriate, lost and corrupt
• Access to Primary care is OK, but quality is poor
• High and uncertain out of pocket: public hospital chargefee for service
• High burden of out of pocket: 100% - 240% of monthlyincome for a single hospitalization: 83% householdsneeded inpatient care experiences catastrophic health
expenditures• Corporatization and “privatization” of public hospitals:
increasing financial barriers
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 3/19
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 4/19
4 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 5/19
5 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 6/19
H Thabrany/ISS UI 6
The Driving Forces for Reforms
1. Amendment of the Constitution, 2002
2. Political Agenda?
3. Perceived Gaps
4. Academic Exercises and International Pressures
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 7/19
H Thabrany/ISS UI 7
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 8/19
8 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 9/19
9 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 10/19
10 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 11/19
11 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 12/19
H Thabrany/ISS UI 12
Political Process
• The Indonesian Law process
– Government submit a Bill-discuss by
Parliament and the Government – Parliament initiate a Bill-response by the
Government by sending ‘partner’ to be
discussed together
• Both initiatives solicit ideas, concepts, etc
from the public
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 13/19
13 H Thabrany/ISS UI
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 14/19
H Thabrany/ISS UI 14
Political Interventions during
Process• In each step, stakeholders may intervene.• Supports by donors: GTZ, EU, ILO, WHO, ADB, AUSAID
• During the process in the Parliament, demos of to support or to reject the Bill have been made by Employer andEmployee Associations
• Opinions also published through News and Articles innewspapers and magazines
• International Bussiness Chamber of Commerces, frequentlyvoiced their oppositions
• An analysis, threatening the Government, was sent by a
USAID consultant• Organized meetings by NGOs supported by USAID to voice
opposition with the concept
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 15/19
The Askeskin, Government
Sponsored Insurance for the Poor • Starting January 2005, the new government,
promising free health care before, paid the first
contribution for 36,7 million the poor.• Administration of the scheme undertook by Askes,
the administrator for National SHI for civil
servants. 40 years experienced with more than 280
branch offices
• Criticisms and complaints were sent, especially by
HMOs (JPKM)
H Thabrany/ISS UI 15
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 16/19
Two Months After Government
Paid the First Contribution• The law was challenged to the Constitutional Court by
provincial legislative, East Java Province, claiming the HI
is a provincial jurisdiction. It was rejected
• Two years after Askes administered, accusation of
mismanaged fund by Askes voiced by some MoH officials
• In 2008, administration by Askes was truncated to only
membership administration. Claim by hospital paid directly
by MoH
• Financial audit was undertaken. No misconduct was found.
But the official at MOH continue to administer the fund by
themselves
H Thabrany/ISS UI 16
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 17/19
H Thabrany/ISS UI 17
After almost five years, the law has not been
implemented and objections are on:
• Mandatory system
• Monopolistic system/central government control
system. Although it is actually by a quasi-government autonomy body
• Shared contribution by employees
• Integration of the system into a single scheme• Demand for provincial control on fund
management
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 18/19
H Thabrany/ISS UI 18
Conclusion
• Indonesia has long implemented social health insurance, but it grows very slowly due to inconsistent
implementation of SHI principles
• Current SHI implementation needs improvement in
benefits, premiums, management, and payment to
providers. This improvement is being undertaken
• A National Health Insurance Program was passed, but
many resistances and trials (including political “lipsticks”
promising “free health care” by candidates of governors)
are being voiced
8/3/2019 Thabrany Nhip Politics Process
http://slidepdf.com/reader/full/thabrany-nhip-politics-process 19/19
H Thabrany/ISS UI 19
Thank You