Slide presentation 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.