শুক্রবার, জুন ১৮, ২০২১

Indonesia’s universal health scheme: the largest national health insurance system of the wolrd!

Indonesia’s universal health scheme: the largest national health insurance system of the wolrd!

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Healthcare system of Indonesia is rated as one of the poorest within Southeast Asia,far behind that of its neighbours Singapore,Thailand & Malaysia. Health care system of Indonesia encompasses government health services, NGOs and the private health sector. Primary health care system are organised in three tiers: on top is Community health centre (Puskesmas), followed by Sub-Centres on the second level, and Village-Level Integrated Posts at the third level.Primary health care systems are free to all citizens of the country. There are approximately 1 doctors per 5000 people (compared to two in Thailand and six in Malaysia) and 0.7 beds available in hospitals per 1000 citizens (compared with 3.3 beds per 1000 people in the UK and 13.7 in Japan). Distribution of hospitals and healthcare facilities are unequal, with urban areas home to more and higher quality health facilities,while remote rural areas are home to under-equipped & very poor quality hospitals.Lack of transportation, infrastructure, energy and isolation are the most common barriers to health sector development and services in remote areas. NGOs have historically been the ones to plug the gaps in healthcare provision. About 70% of the population depends on government run hospitals.

An overhaul of Indonesia’s health care system was long overdue, as it lagged behind many others in the region. In the past, most Indonesians relied on personal money or private insurance while those deemed living in poverty got free public health care — but this left millions stuck in the middle, too poor to afford care but not poor enough to qualify for government assistance! An estimated 60% of Indonesians, mainly state employees, low-income earners, and those with private coverage had some form of health insurance. There have been major changes to the Indonesian healthcare system in recent times. This is largely because just 2 year (August 2014) Indonesia enacted country-wide health insurance scheme that aimed to insure its entire citizen by 2019, what has quickly become the world’s largest national health insurance system. The insurance scheme, Jaminan Kesehatan Nasional (JKN) is implemented by the social security agency Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS). The scheme is being implemented as part of the government’s efforts to direct some of the benefits of strong economic growth into improved welfare. Those in formal employment pay a premium equivalent to 5% of their salary, with 4% payable by employers and 1% payable by employees. Civil servants are automatically enrolled, private companies must sign up staff while the self-employed and those working in the informal sector are required to join themselves. Its mandatory for citizens to join the scheme, the premium of which ranges between $2-$7, in a tiered system of first, second and third-rate care depending on the contributions they choose to pay. The premium for the poorest (9-10%) is paid by the government. There are currently no punishments for people who fail to sign up, but when the system is fully rolled out in 2019, they will face fines.

Another reform aimed at improving healthcare in the short-term is to allow foreign companies to set up hospitals in Indonesia. These facilities will bring foreign expertise to the region as well as modern equipment. It will help increase the quality of healthcare as well as the quantity of healthcare available. Whilst an increase in availability of private healthcare services will not directly solve the problems facing the public sector, the government will at least be able to use the private sector to provide public services until their own infrastructure can be built.

Under JKN, all citizens are now able to access a wide range of health services provided by public facilities, as well as services from private organizations that have opted to join the scheme as providers. JKN care aims to be comprehensive, covering treatment for everyday concerns such as flu through to open-heart surgery, dialysis and chemotherapy. Private insurance continues to play a role by providing for excess or additional coverage of services not included in JKN.

The reason for this reform was many folds. First and foremost, the government of Indonesia wanted to ensure healthcare as it is a constitutional right for all Indonesian people & to secure the health and wellbeing of the county’s population by providing them with guaranteed access to medical facilities and treatment. Next, it was important to the government that Indonesians were comfortable spending their income and bolstering the economy. It is expected that spending on healthcare will increase by 12% a year and reach US$46 billion a year by 2019.

Though the scheme has been criticized for being over-ambitious as the government has already began to run deficits from the program due to its responsibility to subsidize the premiums of nearly of the poor citizens,a lack of competency in administration, and a failure to address the need for improving healthcare infrastructure in remote areas, but JKN exceeded its target for enrolling members in its first year (registering 133.4 million members compared to a target of 121.6 million) and that, according to an independent survey, the customer satisfaction rate was 81%, awareness of JKN was 95%, and that complaints had been resolved within one and a half days on average. So far 78% of the country’s population became covered within 2 years of inauguration of the scheme & it is expected that the entire population will be covered in 2019.While the JKN scheme is an improvement for some sections of Indonesian society, it still has a long way to go if it is to become truly universal by 2019.

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M R Karim Reza

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