ISPOR 2016

1. Universitas Indonesia, Center for Health Economics and Policy Studies
Universal Health Coverage: Case of
Indonesia and Its Problem Solving
Hasbullah Thabrany
Chair, CHEPS UI
Email: hasbullah.thabrany@cheps.or.id
8/5/2016 Hasbullah Thabrany - CHEPS UI 1

2. Universitas Indonesia, Center for Health Economics and Policy Studies
Main Characteristics of
the Ina-Medicare, UHC Indonesia
• A single payer system, JKN, for all Indonesian citizens
(including foreigners). Currently, it covers 165 million
people registered in BPJS Kesehatan (the Corporation
of NHI)
• Comprehensive benefits (A-Z health care) of the most-
cost effective are delivered through public and private
health care facilities contracted with BPJS Kesehatan
• To ensure efficiency, the UHC uses prospective
payments to all contracted providers.
• A Commission of Health Technology Assessment
(InaHTAC) is established to appraise benefits
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3. Universitas Indonesia, Center for Health Economics and Policy Studies
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4. Universitas Indonesia, Center for Health Economics and Policy Studies
The Strengths of the JKN (UHC)
• As a single payer, JKN has monopsony power. It
promote efficiency and massive health reform
• At this time, the medical professionals and
hospitals’ economic power are not strong
enough, so—it shapes the health care system
• There is still strong culture to follow the
Government policy, although the providers are
unhappy, it moves relatively smooth.
• People are not strong enough to reject short term
deficiencies in health care. Resistancy is weak
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5. Universitas Indonesia, Center for Health Economics and Policy Studies
The Challenges
• So many doctors and hospital managers
complained about inappropriate prices of
capitation and INA-CBGs.
• Even doctors in public hospitals complained the
CBG prices. What is fair and unfair prices?
• Generally large private hospitals have yet to sign
contract with BPJS due to unattractive prices
• Many public and private hospitals are pushed to
CHEAT (moral hazard to fraud) to meet their
EXPECTED surpluses or to reduce DEFISITS
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6. Universitas Indonesia, Center for Health Economics and Policy Studies
The Main Problems of JKN
• Contributions and revenues have been inadequate to
purchase good quality of care, especially in private
providers
• Procedures and decision process in setting
contributions and prices are not transparent
• Decision makers have not (yet) practicing evidence
base policy
• Providers have not reacting fairly on capitation and
GBG prices. Instead they shift the costs to patients
• Employees and employers of large companies are
complaining of poor quality of JKN and long queues
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7. Universitas Indonesia, Center for Health Economics and Policy Studies
Example of equity: A study by GIZ on Out of
pocket of expenditures among JKN members
2015
8/5/2016 Hasbullah Thabrany - CHEPS UI
Outpatient inpatient
The OOP spending compared to household income shows a much
higher burden for the poor. (% OOP to the proxy income).

8. Universitas Indonesia, Center for Health Economics and Policy Studies

9. Universitas Indonesia, Center for Health Economics and Policy Studies

10. Universitas Indonesia, Center for Health Economics and Policy Studies

11. Universitas Indonesia, Center for Health Economics and Policy Studies

12. Universitas Indonesia, Center for Health Economics and Policy Studies
Framework for Problem Solving of JKN
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13. Universitas Indonesia, Center for Health Economics and Policy Studies
Actions Needed to Correct
• Large and thorough cost study and analyses, based on
average market costs, to meet fairness in payments.
• Increase payments to, especially, private providers
• Improve quality of care and reduce queues by
contracting more private providers
• Surveys on evidences and the scale of out of pockets
payments due to cost shifting by providers
• Surveys on crowded out members, who do not use the
benefits
• Surveys on other barriers (distant, inadequate supplies,
and other non financial bariers)
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14. Universitas Indonesia, Center for Health Economics and Policy Studies

15. Universitas Indonesia, Center for Health Economics and Policy Studies
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Detail and
more
complete
discussion
on UHC are
here

16. Universitas Indonesia, Center for Health Economics and Policy Studies
The Borobudur temple, built in the 9th century, was
constructed for long time, but it last long!!!
the INA-Medicare will do
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