It is undoubtedly true that nation with unhealthy population has difficulty in being productive and compete with other nations. That is why the State should be able to guarantee every citizen has the right to health/ health care. In its efforts to ensure the right to health, Indonesian government has committed through a variety of legal product. In the 1945 Constitution, article 34 paragraph (2), (3) that health insurance is for the entire people of Indonesia. Law no. 40, 2004 and 32, 2004 that central and local governments require the development of social security scheme. But how is the implementation? Do people already get their right to health care in Indonesia?
In this article, I will try to discuss the right to health care in Indonesia by linking to WHO and ILO health financing frameworks. There are four criteria introduced in the WHO framework (equity, efficiency, feasibility and sustainability). These criteria can explain the right to health/ health care in terms of health financing and its conflict mechanism between them.
In act 36 of 2009, stated that the health budget should be at least 5% of the state budget and 10% of local government budget. This is to ensure the right of society to health care. Even though it increases all the time, it still not more than 2.5%(1), far away from other South East Asian Countries such as Thailand, Malaysia and East Timor which has reached 12 percent of the state budget (2). Therefore, it is not surprisingly that 35% of health expenditure comes from out of pocket (3). But on the other hand, government should be more should be more innovative and have a new strategy to budget control, human resource capacity, law and regulation, and budget planning to prevent inefficient and ineffective of health expenditure.
In terms of pooling side, currently Indonesia is using oligopoly of health insurance carrier. There are PT. ASKES, PT. JAMSOSTEK, ASABRI, JAMKESDA, JAMKESMAS, and many private insurance. These led to inefficiency of health insurances and become a big issue on portability and Coordination of benefit (COB). Therefore, it will be great if all health insurance carrier can be integrated and people have their right to health care where ever they are.
Every person has an equal rights in access to health resources in terms of quality services, safe and affordable. Since end of 2010, Indonesia population who already have health insurance is 59.07% (139 million people). Within 59.07%, it consist of JAMKESMAS (54.8%), JAMKESDA (22.6%), PT. ASKES (12.4%), PT. JAMSOSTEK (3.5%), Company insurance (4.6%) and other private insurance (2%). There are 250 (51%) districts have their own health insurance, and 5 provinces already achieve universal coverage such as South Sumatera, Bali, South Sulawesi and Aceh (1). However, nowadays, government still focusing on vulnerable people to ensure they have right to health/ health care.
Ideally, benefit package should be comprehensive. Some of the health insurances carrier can provide that such as JAMKESMAS and JAMKESDA in rich local government. These lead to inequity for all people in Indonesia. Therefore, central government should develop the standard of benefit package to ensure people’s right to health/ health care which can prioritize on MDG’s and catastrophic disease.
It is generally known that achieving universal coverage with limited resources is not piece of cake. Indonesian government is targeting universal coverage in 2014. In my opinion, since informal taxpayers are very limited currently (4), assuming this will be the same strategy to collect the premium also, then one of the biggest challenge is covering the informal sector. Therefore, if government force to achieve universal coverage and cover the informal sector, government will pay the premium. Then there will be a question of how government can afford it.
To ensure the rights of Indonesian to health/ healthcare, Indonesian government believes that social health insurance is the answer. Using universal social insurance can pool the risk to improve equitable access to health/ health care and prevent impoverishment. It is expected to overcome of health insurance currently, which still becoming a political tool only. It is not totally bad idea, it is greatly increases the people’s right to health/ health care. But, in my opinion, if most of the health insurance resources come from central and local government budget with unlimited benefit package, this will not be able to last long program. This idea will depend on commitment of political and economic condition. And we should not trapped into “charity health insurance” that can be a boomerang of people’s right to health/healthcare.
1. Sedyaningsih ER, editor. Strategi dan Kebijakan Kementerian Kesehatan Menuju Universal Coverage dan Pemenuhan Serta Pemerataan Fasilitas dan Tenaga Kesehatan. Annual Scientific Meeting 2011; Yogyakarta.
2. JPNN. Anggaran Kesehatan RI Kalah Jauh dari Timor Leste. Jakarta: Jawa Pos; 2011 [cited 2011 18/12/2011]; Available from: http://www.jpnn.com/read/2011/11/30/109663/Anggaran-Kesehatan-RI-Kalah-Jauh-dari-Timor-Leste-.