Indonesia - Health

With the enactment of the National Social Security System Act in 2004 and Social Security Providers Act in 2011, the government made a commitment to achieve universal health insurance coverage. The roadmap for implementing the Universal Coverage of Social Health Insurance in Indonesia specifies that Badan Penyelenggara Jaminan Sosial Kesehatan (Health Insurance Provider) will commence on 1 January 2014 and indicates that universal health care will gradually be achieved by 2019.

However, before the National Social Security System is fully in place, a significant proportion of the population is still without health insurance. Though the coverage of existing health insurance programmes has had significant improvements in the last few years, there is currently still around 41 per cent of the population living without health insurance.

Of those having access to social health protection, 32 per cent is covered under the Jamkesmas programme, a tax- funded health insurance scheme targeted at the poor and near poor population. Other types of insurance (including compulsory health insurance for civil servants, health insurance obtained by formal private sector employees, private insurance, and other smaller programmes) mostly cater to the richer population. Among households in the top three deciles in terms of expenditures, 33 per cent of households hold these forms of insurance, compared to only 4.4 per cent of households in the bottom three deciles and 12 per cent of households in the middle four deciles (World Bank, 2011b).

Programmes

Jamkesmas - Health insurance for the poor at central level | data

• Target: The public health insurance scheme, Jaminan Kesehatan Masyarakat (Jamkesmas), previously known as Askeskin, targets the poor and the near poor using a proxy means-testing targeting method. It covers 76.4 million beneficiaries, 32% of the total population (Indonesian Financial Note and Draft State Budget 2013).
• Benefits: The scheme provides beneficiaries with free health care services in community health centres (Puskemas) and third class (basic level) wards in government hospitals and some designated private hospitals. Jamkesmas provides capitation payments to Puskesmas based on the number of poor in the catchment area for primary care services, and pays inpatient services on a fee-for-service basis (WB, Feb 2011). A Diagnosis Related Group System (INA DRG) is recently developed and implemented to hospitals, replacing fee-for-service payments previously used.

 

Jamkesda - Health insurance for the poor at provincial and district level | data

• Target: Jaminan Kesehatan Daerah (Jamkesda) typically targets people who are identified by the local authorities as poor but are not covered by Jamkesmas because of inclusion errors or because they recently became poor. Though Jamkesda programmes are designed to complement Jamkesmas, the two programs generally use completely separate databases and targeting mechanisms. This has resulted in overlaps in targeted groups and has posed considerable challenges in crosscheking recipients. 13.5% of the Indonesian population is covered by Jamkesda progammes.
• Benefits: The level and types of protection vary between provinces and even between districts in the same province, but benefits are typically similar to those of Jamkesmas.

Universal coverage in some provinces
Some provinces allocate local government's funds to extend coverage to other groups that are currently targeted or even to all residents. Bali province's Mandara Health Care Program, started in January 2010, provides free health care to all residents in the province. The pooling of fund is at the level of the province. South Sumatra and Aceh have also implemented a non-contributory social health protection scheme that covers all non-covered population (informal economy either poor or not poor). In South Sumatra the pooling is at the level of the district (which limits the portability of benefits) whereas in Aceh the implementation of the universal scheme was given to PT Askes. Yogyakarta's Social Health Insurance (Jamkesos) program currently provides free health care for the poor (similar to Jamkesda), but has plans to extend coverage to formal and informal workers who are not covered by health insurance. For these groups, different contribution schemes will apply.

 

PT Askes – Health insurance for civil servants and military personnel | data

• Target: Active and retired civil servants, retired military and police officers, veterans and national patriots, and their dependents are covered by a compulsory health insurance scheme managed by PT Askes. The membership of this scheme in 2010 totaled 16,482,331 people (7% of the population).
• Benefits: Members obtain comprehensive benefits through a structured health services mechanism, which is available throughout Indonesia. Active military and police personnel are provided with in-house health care through special military hospitals.

 

PT Jamsostek – Health for private sector workers | data

• Target: Formal sector workers. Employers may opt out from the Jamsostek health insurance under the condition that they provide higher levels of benetis and protection through other channels to their employees. Some employers choose to purchase private insurance for their employees while others choose to establish in-house health services. However, many simply evade the law and do not provide any health protection to their employees. Based on the Ministry of Health's database, Jamsostek health insurance, employer-provided health insurance and health care services, and private and other health insurance cover 6% of the total population. This is a very small number given that one-third of the workforce is in the formal sector.
• Benefits: Until 2011, some high-cost treatments such as heart surgery, hemodialysis, cancer treatment, and HIV/AIDS medication were excluded from this scheme. With the enactment of the Directors' Decision No. Kep/310/2011 in December 2011, Jamsostek now includes coverage for HIV treatment, heart surgery, and hemodialysis. The aforementioned treatmens remain excluded from most private health insurance schemes.

 

Jampersal - Universal delivery care | data

• Target: Women.
• Benefits: Jampersal is a new Ministry of Health programme (started early 2011) that provides women universal free delivery care, including pre-natal and post-natal consultations. The scheme uses a direct payment mechansim based on a flat rate capitation amount, which means the patients do not pay anything. The total delivery package cost is IDR 420,000, including IDR 350,000 for delivery, IDR 40,000 for four anti-natal care visits, and IDR 30,000 for three post-natal care visits.

 

Jamsostek pilot programme for informal economy workers | data

• Target: Informal economy workers earning at least the minimum wage, which amounts to approximately IDR 1 million, but is subject to variations across provinces. The total membershi amounts to approximately 400,000 persons, but since memebers can enter and exit the programme at any time, the number ot members at a given point in time varies widely.
• Benefits: The Jamsostek pilot programme for informal economy workers, launched in 2006, includes health care benefits. The contribution for health care benefits is set at 3% of income for workers without dependents and 6% of income for workers with dependents, where "income" is set at the minimum wage level of IDR 1 million per month.

 

Social security schemes and programs by branch