Indonesia is expected to miss its 2019 deadline for achieving universal healthcare (UHC) due to disparities in medical staff and infrastructure leading to unequal access to the national health insurance programme, and regulatory weaknesses, two local studies have claimed.
IHS Life Sciences perspective | |
Significance | Indonesia is expected to miss its 2019 deadline for achieving universal healthcare (UHC) due to unequal access to the current national health insurance programme (JKN), according to two studies. |
Implications | Indonesia's inequality of access to the JKN is due to disparities in healthcare infrastructure and the number of doctors between developed and less-developed regions, the first study argues. Regulatory weaknesses also lead to the exclusion of certain population groups from the JKN, argues a second report. |
Outlook | The study findings agree with IHS' earlier conclusion that unless the operational aspects of UHC are addressed, Indonesia is unlikely to meet its 2019 target for universal healthcare. |
Indonesia will miss its 2019 deadline for achieving universal healthcare (UHC) due to unequal access to the current national health insurance programme, according to The Jakarta Post, quoting two studies.
The two studies were carried out by the Gadjah Mada University (UGM) Center for Health Service and the Paramadina Graduate School of Diplomacy.
According to the UGM study, which was conducted last year, there is a wide gap in Indonesian citizens' access to healthcare coverage, or Jaminan Kesehatan Nasional (JKN), between developed and underdeveloped regions. The disparity is such that only seven out of 33 Indonesian provinces are expected to have UHC by 2019, according to the study: Jakarta, Yogyakarta, South Sumatra, West Sumatra, as well as some regencies in East Java, Central Java, and South Sulawesi.
The main reason for the gap lies in differences in the numbers of hospitals and doctors, with a lack of medical facilities preventing JKN members from getting access to healthcare, which has led to low claim rates. In Central Java, for example, a single major hospital claims up to IDR60 billion (USD4.8 million) per month, on average, from the JKN. In comparison, hospitals in East Nusa Tenggara (NTT) – one of the poorest regions in Indonesia – claim just IDR30 billion.
In 2014, NTT received IDR700 billion from the JKN for 2.3 million premium payment assistance (PBI) beneficiaries, but spent only IDR300 billion, due to a lack of doctors and hospitals there. As a result, the surplus funds were returned to the Healthcare and Social Security Agency (BPJS Kesehatan), according to the UGM report, and re-routed to more developed and affluent regions.
Compounding the gap is the fact that Indonesia's seven million citizens who do not receive premium payment assistance also absorb a larger amount of government funds. The medical cost for a non-PBI beneficiary was IDR282,139 as of November, with each paying an average premium of IDR27,062 per month, leading to a claim ratio of 1,380%. The high claim ratio is due to the fact that non-PBI beneficiaries typically only register with the JKN once they have fallen ill.
In comparison, PBI beneficiaries cost on average IDR21,977 for each medical service they receive, while government-paid premiums amount to IDR27,478 per person per month, leading to an 88% claim ratio.
The second report, conducted by Paramadina University, listed similar conclusions, and underlined regulatory weaknesses of the JKN programme, which failed to cover particular population groups such as newborn babies – which are not automatically covered – and unregistered low-income citizens, prisoners, orphans, and others. This is due to the fact that their names need official recommendation in order to become PBI beneficiaries. The report concluded that, unless there was a change in regulations, it would not be possible to achieve UHC by 2019.
Outlook and implications
The complex nature of Indonesia's vast geography and considerable disparities between urban and rural areas and health infrastructure mean that the prospects for rolling out UHC by the 2019 target were less than rosy. In fact, the conclusions of the two studies, should they materialise, agree with IHS' opinion that Indonesia's government is unlikely to meet its target.
A major operational challenge in rolling out UHC has been in extending coverage to approximately 32 million informal sector workers who do not qualify as poor or near-poor. Formerly stuck in the middle, this large number of citizens theoretically now receives JKN coverage, although the logistical challenges of collecting contributions from informal workers remain significant.
Compounding the challenges remains the fact that the number of hospitals in Indonesia's poorer regions still remains insufficient. Indonesia has two doctors per 10,000 population, compared to the regional average of 5.9 (source: WHO). Only 51% of Indonesia's population lives in urban areas.
Furthermore, the inadequate funding of the JKN has long been a sticking point, with Indonesia's healthcare budget historically being relatively low, with total healthcare expenditure accounting for only 2.6% of GDP, corresponding to only around USD76.9 per capita in 2010 (source: World Bank). Government spending on healthcare was 3% of GDP in 2012 (source: WHO).