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
•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
(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