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PPP IN SOCIAL HEALTH INSURANCE

14 Des

Firdaus Hafidz; Winter School

Problem statement

Lack of resource to provide universal coverage in a setting of social health insurance.

Recent studies indicate that the private sector –mainly from out of pocket- contributes almost 80% of the health expenditures. According to the best estimates during the last ten years, public financing accounted only 23, 7% of total health expenditure in 2000. With such a heavy dependence on out of pocket health expenditure, social health insurance mechanisms become viable alternatives.

Government has a commitment to develop National Social Security System since 2004. Government has issued Law no 40/2004 about National Social Security System. Now, government has tried to begin with Social health insurance for the poor. With Social health insurance for the poor (Jamkesmas), the 212 million of Indonesian population, roughly 36% (76,4 million) of the population is now covered.

To run the program, it need 5,8 thousand billion IDR to cover the poor. The budget always increases every year but in other hand MoH budget cannot meet the need. But that is not the only problem, (1) Indonesia is a very large country with 212 million people, scattered in about 7000 island, (2)the per capita income of Indonesians is relatively low (i.e. in 2004 it was about US$ 1.000, (3) Many people works in the informal sector, (3) Access to health facility, (4) Lack of capacity to administer the social health insurance, (5) Debate on who will be the insurance body and how is the system.

Project intervention which use PPP approach

To solve all the problem above, we need intervention which is Public Private Partnership (PPP) approach.

Insurance system intervention

There are various alternative-financing systems, (1) Single payer in national or province level, (2) Oligo payer, (3) Single collector, multi payer, (4) Multi Payer in province or district level. Using single collector, multi payer is the best idea for PPP approach. We need to involve nonprofit private sector as a multi payer spreading in Indonesia. With this system, ensure the cross-subsidies between regions and between groups.

The nonprofit private sector of insurance body –multi payer- still collect the money from the community, even it call a single collector which is central. It means that all premium collected will be transferred all to the central. So, It can solve also about informal sector issue which is hard to collect premiums from the community. So, with this partnership intervention, insurance can have better access to people and the people also have a more option choosing insurance body.

Private sector for profit will be a supplement and top up benefit. So, people who have more money and want to have a better quality or benefit, they can pay more to the nonprofit private or public insurance body. So people don’t have to pay double. Beside of private sector on insurance body, government should involve all private provider include private practice to involve in this insurance scheme.

Project Design:

Before:

clip_image001

After:

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Project Planning and Budgeting

Preparatory stage:

1. Issue a regulation on compulsory member for all Indonesia resident

2. Determine the amount of insurance premiums and benefits

3. Bidding on eligible nonprofit and profit private health insurance

4. Contract / signing of memorandum of agreements with all private health provider sector (Hospital and Primary health care)

Implementation:

1. Socialization to community

2. Register all residents

3. Collecting premiums

4. Pilot implementation in one province

Source of Finance:

Project development budget should come from all sector.

• Central Government, should provide for the poor insurance.

• Local Government, should provide for the poor who not eligible in national protection scheme

• Private Sector, provide budgeting for administrate, socialization, and collecting the premiums.

• Community, pay the premiums

Stakeholders analysis for the project

Stakeholders

Position

Power

MoH

+++

++

DHO

++

Private nonprofit insurance

++

+

Public insurance

+

+

Private for profit insurance

+

Puskesmas (Public health service)

+

+

Public Hospital

++

++

Private hospital

+/-

+

Community

++

+++

Academicion

+/-

++

 
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Ditulis oleh pada 14/12/2009 in Health economics

 

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