Bayu Teja Muliawan, M.

Pharm
Director of Pharmaceutical Service

Directorate General of Pharmaceutical and Medical Devices Development

Ministry of Health of the Republic of Indonesia

ISPOR Annual International Meeting

Philadelphia, USA, 16 20 May 2015

Overview of
Indonesia

Geogra
phy

Demographic

Health
care

11S ; 6N , lies at
equator
17,508 islands
5 biggest islands

Population > 238 mil

Pop growth 1,9 %
58 % lives in Java

863 public hospitals

706 private hospitals
9,719 PHCs
Implementing NHI
(JKN) since 2014

- Universal Health Coverage is one of objectives of

health system in Indonesia (Law No. 40/2009)
- Jaminan Kesehatan Nasional (JKN) is the
National Health Insurance which implemented
since 1st January 2014
- JKN is aimed to cover the health service of all
citizens in 2019, incl. promotive preventivecurative-rehabilitative medical benefit package
- It is the role of government to ensure the
sustainable health finance for all the people

Total Expenditure on Health in Indonesia

2008

2009

2010

2011

2012

TEH (in trillion IDR)

140.7

160.3

190.3

214.9

252.4

TEH per capita (in thousand IDR at

current prices)

617.8

695.1

815.3

909.5

1,055.1

TEH per capita (in US$ PPP at

current prices)

208.76

218.61

239.70

252.18

284.79

TEH as % of GDP

2.8

2.9

3.0

2.9

3.1

General government expenditure

on health as % of TEH*

35.4

35.7

37.3

37.5

39.2

Private expenditure on health as %

of TEH**

64.6

64.3

62.7

62.5

60.8

OOP payments as % of TEH

48.4

48.4

46.7

46.9

44.9

Source : Suwondo, et al, 2014, Indonesia National Health Accounts

*excluding Parastatal and Rest of the world expenditure

** Including Parastatal and Rest of the world expenditure

Referral
system

Primary
secondary tertiary

Health
System

Contibution of
private sector

Publicprivate

System
Strengthening

Managed
care

JKN
Until
2013

Increasing access, cost escalation

and quality challenge

Since
2014

Under JKN , it has been developed some policy

tools for cost containment quality
improvement to be implemented by
government, BPJS*, providers, members
Government Ina CBGs (by NCC), HTA (by HTAC), National
Formulary (by NFC), medical audit (by CAB), monitoringevaluation, ensuring supply side and access
BPJS Credentialling for health facilities , Utilization Review
(Monitoring-evaluation)
Provider quality assurance, patient safety, accreditation
Members ID card, contribution, obey to referral system

Provider payment under JKN

Hospitals,
specialized
clinics
(secondary,
tertiary)

PHCs, GP
clinics
(primary)

Inpatient,
outpatient

- Bundling
(DRG)
- Unbundling*

- Capitation

Outpatient

- Non
capitation**

Efforts for improving availability and

affordability of medicines under JKN
REGULATION ON PUBLIC MEDICINES
NATIONAL FORMULARY
List of selected
medicines based on
criteria

E-Catalog

e-tendering
negotiation

List of medicines price

based on tender and
negotiation process
e-purchasing

Cost containment and quality improvement of medicines

Safety, quality, efficacy, affordability of medicines

Potential role of the National Formulary*

Reduces number of drug items
Reduces variability in prescribing
Reduces unnecessary medicines
Reduces health care cost on medicine
Improving patient compliance
More efficient health care budget
Education for provider (EBM)
Education for consumer
*Dwiprahasto, 2014

Pharmaceutical expenditures under JKN*

*National Team for Accelerating and Poverty Reduction of Indonesia, Health Working Group, 2014

Managing cost &

improving quality of
health technologies use

HTA

Under JKN, MoH mandated to

implement HTA based on
Presidential Regulation No.
12/2013 regarding JKN (National
Health Insurance)
Article # 26 : the development of
technology application in the benefit
package should be relevant with the
medical need based on the result of
HTA
Article # 43 : HTA is the responsibility
of Minister of Health

HTA Committee (MoH decree No. 171/2014)

Chairman
Secretariat

PIC

Experts

MoH staffs

The results of the HTAC will be

recommended to the MoH for a
basic benefits package policy
Currently in the process of
developing institutionalization
(incl. stake holder engagement,
developing roadmap, policy
framework) and in the process of
implementing the early stages of
assessment

AdHoc
panels*
* Temporary involvement

Indonesia has already had a system to cover all the

citizens, dan managing cost and improving quality
Challenges
- readiness of supply side
- decentralization role of province and district government
- geographic disparity
- private sector involvement coordination of benefit
- membership of informal sector still needs more assertive policy

Way Forward
- Roadmap supply side, including medicines and medical devices
- contribution of province and district government
- to build an established and more independent HTA organization

Visit Indonesia !!!

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