Kebijakan Strategis untuk mengurangi ketidak adilan dalam mencapai Universal Health Coverage Laksono Trisnantoro Universitas Gadjah Mada InaHEA 2nd National Meeting, Jakarta, 9th April 2015 1 Strategic Policy for narrowing inequity in Universal Health Coverage programs
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Laksono Trisnantoro Universitas Gadjah Mada - inahea.orginahea.org/files/hari2/INAHEA-Laksono-English-Indonesia-New-2015.pdf · • Who get what from BPJS expenditure? • Whether
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KebijakanStrategis untuk
mengurangiketidak adilan
dalam mencapaiUniversal Health
Coverage
Laksono Trisnantoro Universitas Gadjah Mada
InaHEA 2nd National Meeting, Jakarta, 9th April 2015
1
Strategic Policy for narrowing
inequity in Universal Health
Coverage programs
What Happened in 2014• JKN dimulai 1 Januari
2014• Situasi supply-side dalam
keadaan tidak seimbang.- SDM dokter dan kesehatan
tidak merata- Pelayanan kesehatan tidak
merata• Di awal tahun 2015,
berbagai sumbermenyatakan bahwa BPJS kekurangan 2 – 5 Triliun
• JKN started in January 2014
• Supply side is extremely not well distributed across Indonesia- Human resources- Health facilities
- In 2015 some report shows that BPJS is shortage of 2-4 Triliun
2
The Shortage of BPJS
• Pardede, 2015 3
Sumber: Data klaim Bulan Pelayanan Jan s/d Des 2014 (Bulan Pembebanan s/d Jan 2015) dari BPJS, Maret 2015.
Who Gets What in 2014?
• Siapa yang mendapatkan danaBPJS?
• Apakah masyarakatyang membutuhkan?Ataukahjustru masyarakatmenengah ke atas di kota-kota besar?
• Who get what from BPJS expenditure?
• Whether the poor or the better of community?
• Whether people in the remote area or in the big cities
4
In more specific, which member group?
• Kelompok masyarakatmiskin yang dibayarmelalui PBI?
• Kelompok Non-PBI eks PT Askes Indonesia dan PT Jamsostek?
• Kelompok Non-PBI Mandiri (Pekerja BukanPenerima Upah)?
Bagaimana isu Ketidakadilan?
• Poor community paid by central government budget (PBI)?
• The ex PT Askes and PT Jamsostek members and formal sector?
• The Non-PBI Mandiri?
How is equity issue is managed?
5
The Analysis
• Revenue Collection• Pooling• Purchasing
6
Health Financing (simplified)
APBN
BPJS
Tax Income
Non-tax Income
Non-PBI Mandiri
Primary Care
Referral Care
Non-PBI exPT Askes
MoH
Out pof pocket
Other Ministries
PBI
Pemda
7Local Gov
Private Insurance
(19.93 T)
NHA 2009 : (18 T)
489 ( 72.9 T)
l.K20 T
4 T
(67,5 T)
Revenue Colelection
APBN
BPJS
Tax Income
Non-tax Income
Non-PBI Mandiri
Primary Care
Referral Care
Non-PBI exPT Askes
MoH
Out pof pocket
Other Ministries
PBI
Pemda
8Local Gov
Private Insurance
(67,5 T)
NHA 2009 : (18 T)
489 ( 72.9 T)
4 T(19.93 T)
+-20 T
Pooling
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1. APBN1. MoH (47,5 T)—incl. PBI• Other Ministries (13,5 T)• Local Government (6.5 T of
APBN)
2. BPJS Kesehatan• PBI (19,8 T) plus• Non PBI-ex PT Askes• Non PBI-Mandiri
Two Big Pools1. Ministry
of Health
1. BPJS
What happened in the two Big Pools?
APBN
BPJS
Tax Income
Non-tax Income
Non-PBI Mandiri
Primary Care
Referral Care
Non-PBI exPT Askes
MoH
Out pof pocket
Other Ministries
PBI
Pemda
10Local Gov
Private Insurance
Ministry of Health
In 2014:• Small Budget for
Hospital Investment • Human Resources
budget stagnant
Pada tahun 2014• Dana investasi kecil
untuk penambahanpelayanan kesehatandan sumber dayakesehatan
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Kemkes Pemprov Pemkab Pemko Kementerian lain TNI POLRI Swasta