Benefit Package Design for Universal Health Coverage: The case of Indonesia

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Recording of the webinar which focused on the findings of a recently conducted assessment, Financial Sustainability and Coverage Effectiveness of the Indonesian Health Insurance System - The role of benefit package design and pharmaceutical policy”. The assessment of the Indonesian system is part of the German contribution to the European Union Social Protection Systems (EU-SPS) initiative, implemented by the GIZ sector initiative, Social Protection.

Indonesia introduced a national health insurance programme (known as JKN) in 2014. With the reform, a single health insurance carrier (BPJS Kesehatan) was established to operate the JKN scheme. JKN today covers over 170 million people, 91 million of which are classified as poor and receiving contribution subsidies from the government. The scheme aims to achieve Universal Health Coverage (UHC) for the entire population of 250 million.

JKN policy design and implementation have made re­markable progress. However, there have been challenges in the implementation of such large-scale reform. A major challenge is the financial sus­tainability of the scheme. After the first year of opera­tions, the balance resulted in a deficit of about 15% of the fund. As spending on medicines accounts for a significant cost factor, it is necessary to examine reimbursement patterns. Moreover, there is evidence, suggesting that pa­tients still incur out of pocket (OOP) expenses, specifically for medicines.

The objective of the assessment was to develop recommendations to:

a.) ensure financial sustain­ability and cost containment within JKN and

b.) to effectively protect patients from OOP.

Therefore, an in-depth analysis of the benefit package design process, focusing on pharmaceutical policy and reimbursement decision making under the JKN, was performed.

Looking across health systems globally, the challenges JKN is cur­rently confronted with are not unique. Aging populations, a rise in non-communicable diseases, and expensive new medicines, have lead to higher medical expenses, and therefor increased costs for national payer(s), i.e. national health insurance(s) and/or other bodies funding health care. In response, various strategies and tools to handle the respective challenges are emerging. Based on international best practices, detailed recommendations for Indonesia's system were developed.

The presentation and discussion of the results will be valuable for UHC practitioners and policy makers dealing with decision making on benefits, reimbursement, pharmaceutical policy, pricing, procurement, as well as strategic purchasing aspects such as cost containment, provider payment and health financing for UHC in general.

 

Presenter:

Ioana Ursu, PharmMD, former Secretary of State in Romania and Director of Mapping Health Ltd

Discussant
Prof. Dr. Hasbullah Thabrany, Senior Advisor to the Social Security Council of Indonesia (DJSN)

Moderator: 

Viktoria Rabovskaja, GIZ Global Alliances for Social Protection 

 

This webinar initiated a webinar series on the outcomes of the EU-SPS initiative, taking place from January to June 2018.

The webinar is also part of the series on Benefit Package Design for Universal Health Coverage, supported by the GIZ programme Global Alliances for Social Protection. The first webinar, which was held on 26 October 2017, can be accessed here:

Benefit Package Design for UHC: Introducing a framework for systematic decision making on pharmaceuticals, country experiences and global best practices