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Politics of National Health Insurance of Indonesia: A New Era of Universal Coverage. Hasbullah Thabrany Institute for Social Security, University of Indonesia hasbullah.thabrany@ui.edu. Conditions of 2004.
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Politics of National Health Insurance of Indonesia: A New Era of Universal Coverage Hasbullah Thabrany Institute for Social Security, University of Indonesia hasbullah.thabrany@ui.edu H Thabrany/ISS UI
Conditions of 2004 • Government financing mainly trhough supply side subsidy: inappropriate, lost and corrupt • Access to Primary care is OK, but quality is poor • High and uncertain out of pocket: public hospital charge fee for service • High burden of out of pocket: 100% - 240% of monthly income for a single hospitalization: 83% households needed inpatient care experiences catastrophic health expenditures • Corporatization and “privatization” of public hospitals: increasing financial barriers H Thabrany/ISS UI
The Driving Forces for Reforms1. Amendment of the Constitution, 20022. Political Agenda?3. Perceived Gaps4. Academic Exercises and International Pressures H Thabrany/ISS UI
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 H Thabrany/ISS UI
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 and Employee Associations • Opinions also published through News and Articles in newspapers and magazines • International Bussiness Chamber of Commerces, frequently voiced 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 H Thabrany/ISS UI
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
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
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 H Thabrany/ISS UI
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 H Thabrany/ISS UI
Thank You H Thabrany/ISS UI
