Successes and Quality

Challenges of JKN
Hasbullah Thabrany
• Senior Policy Adviser, ThinkWell.org
• Chairman InaHEA. The Indonesian Health Economic
Association
 Outlines

• Concept and Design of JKN, The National

Health Insurance Scheme
• Current Successes
• Main Challenges
• Quality Issues
• Ways Forward

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 Current Successes

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 Successes of JKN: Popual on Coverage
and Pooling of Funds
Popula on Coverage, Funds, IDR Trillions
millions
80
200 70
60
150
50
40
100
30

50 20
10
0 0
2014 2015 2016 2017 2014 2015 2016 2017
Souce BPJS report 2017
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 Trend of # Visits/Admissions of the
JKN, million cases

U liza ons 2014 2015 2016 2017

Primary OP 66.8 100.6 120.9 150.3
Secondary OP 21.3 39.8 49.3 64.4
Inpa ents 4.2 6.3 7.6 8.7

It should be noted that the number of visits were based

on the BPJS Claim data. The claim data exclude those
people who had con buted (member) but they did not
use the benefits
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 Evidences Show:
Increassed
accesses to
inpa ent (IPD)
and Outpa ent
(OPD) were
higher among the
poor and near
poor compared
to the rich.
However,
inequi es
remain, due to Source: HP+ Policy brief USAID
previous system.
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 Diserta on of Nizar Shihab (2018) Shows Higher Increase of
Inpa ent Rates in Rural Areas compared to in Urban Areas
Public Hospitals Private Hospitals

Rural Urban Rural Urban

Shihab measured delta, increased of inpa ent rates a er the JKN in 2015 compared to
2013 rates and rasio of post JKN to pre JKN rates
Sumber:(Disertasi(Nizar(Shihab,(Unhas,(Sept(2018(

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 Access to Inpa ent Care in Public Hospitals Has
Reached Equity. However, Access to Private
Hospitals Remain Pro Rich

Source: Working Paper TNP2K Access. 2018 Previous barier to accesses to private
hospitals has not been totally
removed in three years of JKN
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 However, Concentra on Curves Show
Evidence of Improvement of Equity
POST JKN
PRE JKN

Source: Working Paper TNP2K Access. 2018

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 More Cases of Birth Assistances by Doctos.
C-Sec ons Increased? Good or Bad?

Source: HP+ Policy brief USAID, 2017

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 Main Challenges

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 FACTS: The Average Contribu on Rates
were TOO SMALL
Segment 2014 2015 2016 2017
Low income, Na onal 19.225 18.866 22.699 22.879
Waged, Public 81.538 76.057 73.909 76.055
Waged, Private 29.502 42.130 62.684 64.888
Non-Waged 17.356 26.038 24.677 22.038
Low Income, regions 12.851 17.631 19.809 19.721
Average 32.094 36.144 40.756 41.116
Calculated from BPJS reports to DJSN. USD ! = IDR 15,000

No private health insurance

r could affo d such a low average
premiums to cover the same benefit, even if the amount is
mul plied three mes more.
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 Fact – Stunted JKN
JKN: Severe Anemia and Malnourished

High OOP

OOP
Ideally, the JKN
share should at
least 50% THE
when the
JKN Expenditure share popula on
is ve
on 15-18% of the Total en coverage
h
Health Expenditure
p re reached 70%
o m
c
74 % Popula on coverage
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 How About Quality of Care?

Subjective and Objective

Quality require higher input
of fund

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 Share of JKN FUNDS Remain Low and OOP Remain High
Financing Schemes 2012 2013 2014 2015 2016* 2012 2013 2014 2015 2016*
HF.1 Government schemes and compulsory
contributory health care financing schemes 85.8 105.7 124.2 154.3 191.5 30.2% 32.3% 32.7% 37.0% 40.7%

HF.1.1.1.1 Ministry of Health 12.3 14.4 15.1 19.9 22.7 4.3% 4.4% 4.0% 4.8% 4.8%
HF.1.1.1.2 Other ministries 3.8 4.6 4.3 4.7 5.0 1.3% 1.4% 1.1% 1.1% 1.1%
HF.1.1.2.1 Provincial government 16.6 19.4 21.3 20.1 23.3 5.8% 5.9% 5.6% 4.8% 5.0%
HF.1.1.2.2 District government 35.6 43.3 36.1 48.2 70.0 12.5% 13.2% 9.5% 11.5% 14.9%
HF.1.2.1 Social health insurance 17.4 24.1 47.3 61.5 70.4 6.1% 7.3% 12.4% 14.7% 15.0%
HF.2 Voluntary health care payment
schemes 41.0 53.2 70.8 64.4 66.7 14.4% 16.2% 18.6% 15.4% 14.2%

HF.2.1 Voluntary health insurance 8.3 9.7 10.2 10.5 13.1 2.9% 3.0% 2.7% 2.5% 2.8%
HF.2.2.1 NPISH 2.0 2.1 2.3 3.4 3.5 0.7% 0.7% 0.6% 0.8% 0.7%
HF.2.3 Enterprise 30.7 41.3 58.4 50.6 50.1 10.8% 12.6% 15.3% 12.1% 10.7%

HF.3 Household out-of-pocket payment 157.2 168.9 185.2 198.7 212.0 55.4% 51.5% 48.7% 47.6% 45.1%

Total (Rp trillion) 284.0 327.8 380.2 417.4 470.1 100% 100% 100% 100% 100%
Share of THE (% of GDP) 3.3 3.4 3.6 3.6 3.8
THE per Capita (USD) 123 126 127 122 137

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Note : Source: NHA, Prastuti, 2018 – interim results
 Per Capita Total Health Expenditures
Year of 2015:
Remain Low S Kore: 2.013
UK: 4.356
600 Indonesia China USA: 9.356
Malaysia Philippines Indonesia: 112.
500 Thailand Turkey JKN: 30
Low & middle income
US$ per kapita

400

300

200

100

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00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
From various World Bank Data, 2018.
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