Discussions about Jamkesda with David Dunlop (GTZ), Matthias Deters, Jan Van Lente (AOK) and friends from the District and Province Health Office of Jogjakarta.
The team of GTZ and AOK want to assist the development of regional health insurance. How is the best models to integrate between regions and provinces as well as harmonization with the national. And later with the right formulation to be submitted to DJSN. Because as we know there are differences in premiums, benefits and others in each region.
In Jamkesda development, with the integrated decentralization concept, integration is required horizontally and vertically. With the management of health insurance which is not exclusive, it can overcome the portability problems more easily.
Forward concept of horizontal integration is the existence of Bapel existing in each area both commercially and socially. Must have a coordinator in each district (county). So that could be collected all the data on money, etc. participants. This is for Local Government Planning, for example: beds, capacity etc. In that way, the area can match the standards of service and each customer has only 1 type of insurance / health insurance. In addition to horizontal integration, vertical integration is standardization benefit package or SPM that may be used as a standard derived from the center. But if you have more citizen ability, it can be added according to the capability itself. In terms of portability is often feared if not centralized, each district may have the full responsibility of the participants from each district. However, if the participant out of the district, then there is the responsibility of the provinces. And if the participants out of the province, there is a responsibility of the center. So that, it is required for the agreement and the issuance of rules to regulate it.

Currently there are 68 regions have developed independently Jamkesda. The problem is that each area:

  1. Still hesitant to legalization and how is the technical.
  2. Less of experts
  3. There are a variety of premiums, benefits -> this is because national norms are not set standards, and also because the capacity and policies for each region
  4. Infrastructure of health facilities
  5. Lack of human resources.
  6. Working together the various regions and the center has not been established, still working on its own.
  7. Regional central contribution was limited.
  8. Sometimes the recipient is still double Jamkesmas and Jamkesda.

Lack of centralization are:

  1. Long realization.
  2. Lack of budget.
  3. And the region does not agree if all the money collected from each region to the center, they even want to vice versa, the money from the center to help local
  4. Later if it is realized, everything that matters must wait for decision on the central level and the chain takes a long troubleshooting. Areas can not act as safe guarding.

The next question is, what the difficulties in building the current Jamkesda?

  1. Membership. There is a difference of data of poor in the central and regional levels. At the central level there are 7 aspects with 11 indicators, while at the regional level there are 7 aspects with 18 indicators.
  2. Collection of premiums. Like it or not, for the moment only premium collection is voluntary. But according to the experience in Vietnam, there is a voluntary system mandatory. It is a community made the decision to join the program or not. But after the community agreed to follow, then the character becomes obliged to pay the premium.
  3. The best model? Whether this BLUD can answer everything? Because the long process and good arguments.
  4. Benefit package. If Jakarta citizen come to Jogjakarta with the same benefit package, but can not be avoided in Jakarta facility may be better than Jogjakarta, although the same class.

Well, with the whole problem, we need to think together and work together with mutual support for the creation of universal coverage.


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