RSS

Purbalingga Insurance Scheme

04 Apr

Development of the local health insurance system in Indonesia has been going on long enough. These efforts have been initiated since decentralization era which mandated the development of local social security system. Some of local health insurance scheme tried to apply social health insurance principle. Until 2008, there are already around 60 local health insurance scheme. Purbalingga is the one district in Indonesia which has a sucessfull small scale of insurance.2

 

Organisation

Purbalingga insurance scheme (Purbalingga Jamkesda) has been developed since 2000 by District Head Decree. District regulation no. No. 09 Tahun 2010 stated that Purbalingga Jamkesda consist of 2 bodies, which is Health insurance scheme board (DJKK) and Jamkesda Carrier (Bapel Jamkesda).1

Structure of Jamkesda Carrier consists of:

  1. Head of Jamkesda
  2. Secretary
  3. Head of sub department
  4. Head of of informatics system management sub department
  5. Head of sub department of member and complain sub department
  6. Head of finance department
  7. Head of health services department

Function of Jamkesda:

  1. Financing management
  2. Membership management.
  3. Informatics system management.
  4. Health services packaged development.
  5. Dissemination of health services Information to members.

Membership (number, structure)

One of the Jamkesda carrier function is membership management to keep it up-to-date, start from registration, distribution of card member, mutation and termination. Purbalingga Jamkesda has Fungsi dari Bapel adalah mengelola data peserta agar tetap up-to date yang dimulai dari pendaftaran, pemberian kartu peserta, mutasi peserta dan terminasi. Jamkesda Purbalingga memliki sasaran penduduk yang berbeda-beda. Sasaran utamanya adalah penduduk non-miskin yang belum mempunyai jaminan kesehatan dan kepesertaannya bersifat sukarela. There are 3 types of membership:

  1. Poor
  2. Post-poor
  3. Non-poor

Membership was growing. Since 2001 there were 67,707 family and became 106,126 family in 2005. But since 2007, poor family covered by National health insurance for the poor (Jamkesmas). 3

image

 

Premiums (how much, how often are they paid)

It is generally known, that most of Jamkesda in Indonesia fully depend on subsidy –tax basis-. But Purbalingga Jamkesda conduct insurance principal which collect premium from voluntary membership.

There were 5.400 Jamkesda socialized health cadres, collected premium, and help people of health services process. Premium payment can be by instalments payment. In some villages premium rice were sold after the which it was collected. Premium administrated by a non-profit bodies.

Permium increased along with increased of public welfare. In 2001, the premium per family per year is set to 25,000 IDR, Rp 33,750 IDR in 2005. In 2007, the premium was 100,000 IDR, and became 120,000 IDR per family per year since last year. 1

image

Services (e.g. basic benefits, catastrophic expenditures)

The Purbalingga Jamkesda offers a benefit package of outpatient and inpatient with certain of limitation. Health services are provided through government health facilities, such as health centers (Puskesmas) and District hospitals. It is also possible to private practice and private hospital which has contract with Purbalingga Jamkesda.

Detail of benefit package: 1

  1. Health services in Puskesmas (inpatient and outpatient):
    1. Health services placed in Puskesmas and its network.
    2. Health services cover health examination, dentist and minor surgery.
    3. Delivery up to 90.000 IDR for post-poor and 100.000 IDR for non poor people
    4. Lab up to 15.000 IDR
    5. Inpatient in Puskesmas, up to 3 days with 150.000 IDR/ day for post poor people and 175.000 IDR per day for non poor people. 
  2. Health services in hospital
    1. Health services place in District hospital.
    2. Formularium for drugs.
    3. Nutrition consultation.
    4. inor surgery and physiotherapy. Tindakan bedah minor dan fisioterapi
    5. Intermediate services:
  3.                     i. Laboratory 15.000 IDR

                   ii. ECG

                   iii. Ultrasonografi (USG) 30.000 IDR

                    iv. Rontgen 25.000 IDR

c. Inpatient in Class III room, up to 30 days, and surgery up to 600.000 IDR.

Table 1. Top 10 Diagnoses in Puskesmas in 20062

No.

Diagnoses

Frequency

1.

Respiratory infection

11,108

2.

Myalgia

8,412

3.

Gastritis

5,254

4.

Skin infection

4,123

5.

Skin Allergic

3,548

6.

Conjunctivitis

2,358

7.

Tinea

1,168

8.

Penyakit pulpa dan jairngan periapikal

934

9.

Hypertension

714

10.

Typhoid

474

Government involvement/subsidies

The insurance carrier are part of the government, those all operational cost covered by district budget. And Premium for poor people are fully covered 100.000/family/year and 40% is subsidized to post poor people now a days.

Relation to other health financing schemes, e.g. social health insurance of this scheme.

Since there is no people has more than 1 of health insurance, there is no coordination of benefit mechanism. Since 2010, Jamkesda Purbalingga already integrated with Central Java Jamkesda (Province level) and Jamkesmas since 2007 to achieve universal health coverage. 1

References

1. Martabat. Provinsi Jawa Tengah. 2012 [cited 2012 3 April 2012]; Available from: http://www.jamsosindonesia.com/jamsosda/cetak/95.

2. Gani A, Thabrany H, Pujianto, Yanuar F, Tachman T, Siregar A, et al. Report on Assesment of Health Financing System in Selected Districts and Municipalities. Jakarta: Australia Indonesia Partnership2008.

3. Anna LK. Saling Tolong untuk yang Sakit. Kompas; 2011 [cited 2012 4 April 2012].

 
Tinggalkan komentar

Ditulis oleh pada 04/04/2012 in Health economics

 

Tag:

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

Logo WordPress.com

You are commenting using your WordPress.com account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s

 
%d blogger menyukai ini: