Universitas Indonesia, Center for Health

Social Security
Economics
Studies
and Policy Studies

Emerging Issues in Universal Health Care and

Health Insurance
How Far UHC in Indonesia Meet UHC Goals?
Hasbullah Thabrany
hasbullah.thabrany@ui.ac.id
Presented at the Asia Pacific Social Protection Week, Asian
Development Bank, August 1-5, 2016
DISCLAIMER: This presentation does not necessarily reflect the views of ADB or the Government concerned, and ADB and the Government cannot be held
liable for its contents.

Universitas Indonesia, Center for Health Economics and Policy Studies

Indonesia Pop 255 million

GDP/Capita 2015, US + 4,300

+ 3,200 miles

Indonesia is such a big country, is single payer

possible ? Now, it is!!!
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Changes in the Proportion of Burden of Diseases, by

Group of NCD, CD and Injuries in Indonesia
70

NCD

CD

Injuries

60

Percent

50
40

30
20
10
0
1990

2000

2010

2015

Year
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160,000.00

Private Health Expenditures

2005-2012

60.0%

140,000.00
50.0%
120,000.00

40.0%

100,000.00

80,000.00

30.0%

60,000.00

% Tot H Exp

IDR Million

Private Out of
Pocket health
expenditure
increased from
dari IDR 42,3
Trillion (2005)
to IDR 113,2
(2012), about
USD 11 Billion.
Proportionally,
OOP decreased
from 55% to
45% of THE

20.0%
40,000.00

Private health insurance

10.0%

20,000.00

0.0%
2005

2006

Asuransi Kesehatan Swasta

2007
OOP

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2008
NPISH

2009

2010

2011

BUMN dan Pers.Swasta

2012
% OOP dari TEH

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Health Care Refrom is a Must

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Universitas Indonesia, Center for Health Economics and Policy Studies

Current Achievements
167 million people register to a single payer, BPJS
1,900 public and private hospitals sign up to serve the
members
Long queues in almost all hospitals, signaling increasing
access to medical care
Outpatient rates for specialist care reaches stability on
average 24 visit/1,000 members per month
Inpatient rates reach stability at 3.7 admission per
1,000 members per month
However, overall utilization rates remain low by the
international standards
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presented as CHE, while Capital Expenditure is classified as different dimension.

Universitas Indonesia, Center for Health Economics and Policy Studies

Indonesia THE in 2014 was accounted for Rp377.8 trillion, or equal to US$31.8 billion (figure
2). About 96.2 percent of THE (Rp363.5 trillion) was CHE and the remaining 3.8 percent
(Rp14.3 trillion) was capital expenditure. The proportion of THE to GDP in 2014 was
estimated at 3.6 percent, slightly increased from previous years. While THE per capita
reached Rp1, 498,091 (US$126).
3.5%

Rp Trillion

350.0

3.4%

3.4%

3.4%

3.6%

4.0%
3.5%

300.0

3.0%

250.0

2.5%

200.0

2.0%

150.0

1.5%

100.0

1.0%

50.0

0.5%
237.2

264.2

293.5

325.9

Share (%) of GDP

400.0

377.8

0.0%
2010

2011
THE

2012

2013

2014

Share THE as % of GDP

Figure 2. THE and the Proportion of THE to GDP, 2010 - 2014

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4. Current

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Health Expenditure (CHE)

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Universitas Indonesia, Center for Health Economics and Policy Studies

US$ = 13,010
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Universitas Indonesia, Center for Health Economics and Policy Studies

In Conclusion
JKN is working in increasing access to
medicines and drugs, especially for those
who have been suffering from chronic
diseases. However, the problems remain
Please keep in mind that the JKN is not the sole
contributor to the UHC. Other insurance (local
governments, private insurance, employers
coverage) also contribute with various degree
of protection
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THE to GDP was at 3.6 percent, lower than many other developing countries, such as Viet
Universitas
for Health
Economics
and
Studies
Nam (7.1 percent)Indonesia,
and PhilippinesCenter
(4.7 percent),
even though
Indonesias
GDPPolicy
per capita
is
higher than both of those countries. It was even much lower compared to the developed
countries such as Australia (9.4 percent) and Japan (10.2) percent. It is expected that GDP
per capita of a country reflects its the per capita health expenditure, the higher income of
the country, the higher its health expenditure.

We Have been Spending TOO LOW for

Health, NHA 2016
Table 9. GDP per Capita, THE Per-capita, and Share of THE to GDP in Selected Countries
in the Asia-Pacific, 2014
Country

GDP per Capita

(US$)
891.5

THE (US$ million)

THE as % of GDP

1,084.1

THE per Capita

(US$)
20.3

India
Laos

1,600.7
1,745.9

97,139.9
217.9

75.0
32.6

4.7
1.9

Viet Nam
Philippines

2,014.7
2,870.5

13,158.7
13,403.8

142.4
135.2

7.1
4.7

Sri Lanka
Indonesia

3,634.6
3,523.6

2,625.5
31,838.1

127.3
126.3

3.5
3.6

Thailand
China

5,519.4
7,565.2

24,407.3
574,799.0

360.4
419.7

6.5
5.5

Malaysia
Republic of Korea

10,933.5
27,942.7

13,630.1
103,989.1

455.8
2,060.2

4.2
7.4

Japan
Singapore

36,201.4
55,909.7

470,671.7
15,155.9

3,703.0
2,752.3

10.2
4.9

Australia

64,008.9

140,035.3

6,031.1

9.4

Myanmar

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2.3

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Per capita health expenditure of a given country can be compared with other countries

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Universitas
Indonesia,
for
Health
Economics
and Policy
Studies
Spending
by function Center
in CHE and
financing
agent
can also be analyzed
using this
SHA
framework (figure 7). Approximately, 64.6 percent of personal healthcare spending was
financed from private agents; reversely 72.5 percent of collective healthcare spending was
from public agents. Personal health care covers inpatient, outpatient, rehabilitative and
ancillary cares, drugs and medical goods, while collective healthcare covers preventive care
and administrative management, system and health financing.

The JKN Contribution to the THE is still

Small. NHA 2016
100%
90%

0.05%
12.1%

ROW

20.0%

80%
70%
60%

7.6%

8.6%

Others Private (Commercial insurance companies,

Corporations, NPISH)

52.5%
Households

50%
41.0%

40%

JKN

30%

Social Health Insurance Agency

13.9%

20%
10%
0%

Subnational government
17.6%

22.9%

3.8%

Central government

Personal healthcare Collective healthcare

Figure 7. CHE and Function according to Healthcare Financing Agent, 2014

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During 2010-2014, CHE by Hfunction

SHA 1.0 showed a different pattern as compared 28
Thabranyusing
- HC reform
to figures using SHA 2011 classification, particularly function for administration, system,

Universitas Indonesia, Center for Health Economics and Policy Studies

Most Problems
Overall financial protection of JKN has not reached
optimum level, since the contribution of JKN to the
THE was only 14% for 65% of the population coverage
The majority of employees of the large employers and
high rank government employees have not utilized full
benefit. Only the very high costs care are utilized. It
signal perception of poor quality
Making all stakeholders understood the system details
remain big challenges for this large country
Inadequate contribution and the level of prospective
payments to private health care providers are the root
for sub optimum JKN
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Universitas Indonesia, Center for Health Economics and Policy Studies

The Borobudur temple, built in the 9th century, was

constructed for long time; it last long!!!
So we expect the INA-Medicare will do

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Major Debates and Complaints will still be

Observed in the next 2-5 Years before the
New System Reaches the Maturity and
Stability

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