New Health Insurance in Indonesia

New Health Insurance in Indonesia

By Bayu Aditya

Azhari MaulanaBudi AriwibowoPrima MaharaniLisa DwipayomaRama Dani Putra

Introduction

• Choosing good health insurance in Indonesia somehow becomes dilemma for insurance applicant. Knowledge about insurance become one of factor which make it happened. This is also caused by many features that given by insurance company which makes many consumers become confused. With increasing health insurance needed in Indonesia, make many companies compete to produce insurance product which suit with consumer needed.

Cont…

• Besides insurance companies, our government also has a program which helps all Indonesian people to increase their social and health. Government policy on the National Health Insurance (JKN) and The National Social Security Agency (BPJS) needs to be known and understood by all the people of Indonesia. It is necessary dissemination of information through dissemination to all stakeholders interests and the public at large

History

• The right standard of living for the health, well being and have family is human right and recognized by all nations in the world, including Indonesia. Recognition that listed in the Declaration of the United Nations 1948 on Human Rights. Article 25 Paragraph (1) Declaration states, every person is entitled to get good living for the health and welfare himself and his family including food, clothing, housing and medical care and also social services required and the right to security in the event of unemployment, illness, disability, widow / widower, old age or Other circumstances that lead to a shortage living, which is out of his control.

• Under the Declaration, after World War II some countries take the initiative to develop social security, include health insurance for all residents (Universal Healt Coverage). In the trial 58th 2005 in Geneva, World Health Assembly (WHA) underlines the need for the development of the system ensure the availability of health financing community access to health services and provide protection to them against financial risk. 58th WHA passed a resolution stating, sustainable health financing through Universal Health Coverage held through an insurance mechanism social health. WHA also advised the WHO to encourage state-member states to evaluate the impact system changes health financing to health care when they move towards Universal Health Coverage.

• In Indonesia, the Pancasila state philosophy and the basic precepts-especially 5 also recognizes civil rights to get health. This right is also enshrined in the Constitution and Section 45 of Article 28 H 34, and is set in the Law. 23/1992 which is then replaced by Law 36/2009 on Health. in Law 36/2009 affirmed that every person has the same rights in gaining access to resources in the health sector and obtain health care safety, quality, and affordable.

• In 2004, issued Law 40 of the National Social Security System (Navigation). Law 40/2004 tell that social security mandatory for all residents including the National Health Insurance (JKN) through The National Social Security Agency (BPJS).

• Law No.. 24 of 2011 also establishes, Social Security The National will be held by BPJS, consisting of BPJS of Health and BPJS of employment. Special for National Health Insurance (JKN) will be hosted by the implementation of BPJS of health starting at January 1, 2014. Operationally, the implementation poured JKN Government Regulation and Regulation of the President, among others: Government Regulation No.101 of 2012 on Aid Recipients Contribution (PBI); Presidential Regulation. 12 Year 2013 concerning Guarantee Health, and JKN Roadmap (Roadmap National Health Insurance).

• To supports the implementation, the Ministry of Health giving priority to the health insurance reform health. The Ministry of Health is working on a regulation form of regulation, which would be a legal umbrella for regulate, among others, health care, health services level First, health care referrals and advanced levels. Regulation Ministers will also set the type and price ceilings medical device and drug services medical consumables and materials for participants Warranty National Health.

What is BPJS?

• BPJS is a law department which have made for hold social security program. BPJS consist of BPJS of health and BPJS of employment.

• Health social security orginizing department ( BPJS of health) is law department which have made for health security program. This department start the operation at January 1st 2014.

What kind of social security are in BPJS?

• Health security• Work accident security• Old age security• Pension security• Dying security

Who become BPJS of health participant?

• All Indonesian people have to become BPJS participant which organize by BPJS including foreigner who have work in Indonesian at least 6 months and have paid premi.

How many group are BPJS of health participant consist of ?

• There are 2 group of participant, they are:1. Premi recipient (PBI) health security2. Non premi recipient ( Non PBI) health security

Premi recipient (PBI) health security

• PBI is indigent and poor people, with participant establishment who have been set by law.

Non premi recipient ( Non PBI) health security

• Non PBI consist of• Employee salary recipient and family, such as

– Civil employee– Indonesian Army – Indonesian Policeman– Goverment official– Private employee– All employee who doesn’t include to a to e which receive salary

• Non Employee and family, such as– Investor– Employer– Pension recipient, consist of

• Civil employee who receive pension salary• Army and policeman who receive pension salary• Widow, fatherless and motherless from pesion salary recipient • Goverment official who receive pension salary

– Veteran– Heroes

What are Right and Duty of participant ?

• Right of participant1. Get member card as valid evidence to get health

care.2. To get benefit and information about right and

duty also procedure about health care 3. Get health care in health facility which work all

with BPJS4. Told lamentation , critic, and suggest by spoken

or written to BPJS office.

• Duty of participant1. Apply her/himself as participant and also pay the

premi which the cost have been set by law2. Report participant data modification, including

marry, divorce, dying, move and change facility class.

3. Keep the member card from broke, lost, or be used by other people who doesn’t have right on it

4. Obey all rule and procedure about health care.

What kind of service health care are in warranty?

• a. Primary health care, ie non-health care specialist include: 1) Administrative services 2) preventive and promotive services 3) examination, treatment, and medical consultation 4) non-specialist medical measures, both operative and non-operative

• 5) Drugs and medical materials consumables services6) Blood transfusion in accordance with medical needs 7) 1st level Laboratory diagnostic investigations and 8) Hospitalization first level according to the indication.

• b. Advanced level referral health services, ie services health include: 1) Outpatient which includes:

• a) Administrative services b) Examination, treatment and specialist consultations by specialists and subspecialty c) act in accordance with a medical specialist, medical indications d) Drugs and medical materials consumables servicese) implantable medical devices f) Support diagnostic in accordance medical indications g) Medical Rehabilitation h) Blood Services i) The services of forensic medicine j) Corpse services in health facilities.

• 2) Hospitalization which includes:• a) non-intensive inpatient treatment

b) inpatient care in intensive care. c) other health services determined by the Minister

What services are not covered?• 1.Health services are done without going through the procedure

as stipulated in applicable regulations. 2. Health services in health facilities do not in collaboration with the Health BPJS, except for emergency cases. 3. Health services has been secured by security programs workplace accidents to disease or injury due to accidents employment or employment relationship. 4. Health services performed abroad

• 5. Health services for cosmetic purposes and / or aesthetic. 6. Services to overcome infertility (Getting Descendants). 7. Leveling dental services (orthodontics). 8. Health disorders / diseases caused by drug addiction and / or alcohol.

9. Health problems from accidentally hurting yourself, or as a result of hobbies are a danger to themselves.10. Complementary medicine, alternative and traditional, including acupuncture, shin she, chiropractic, which has not been declared effective based health technology assessment (Health Technology Assessment / HTA). 11. Medicine and medical treatment which including experiment (experiment). 12. Contraceptives, cosmetics, baby food, and milk. 13. Household health supplies. 14. Health care programs that are already guaranteed in the accident traffic in accordance with the provisions of the legislation. 15. Catastrophic health services, extraordinary events / outbreaks. 16. Cost of other services that are not related to benefits provided health insurance.