Comprehensive Assessment of Indonesia's National Health Insurance Scheme
The comprehensive assessment of Indonesia's national health insurance scheme was coordinated by the National Team for Acceleration of Poverty Reduction (TNP2K), with support from USAID through HP+.
In 2014, Indonesia embarked on an exciting and ambitious strategy to move towards universal health coverage through Jaminan Kesehatan Nasional (JKN), the country's single-payer national health insurance scheme. The Government of Indonesia spends significant resources to cover membership costs for the poor and near-poor under JKN. The scheme currently incurs annual deficits which are growing. Given the significant investments in JKN, Indonesia's Ministry of Finance and other ministries have an interest in understanding whether JKN delivers a positive and equitable impact on the social sector and population health. In particular, ministries are interested in whether JKN increases healthcare-seeking behavior, engages the private health market in a way that stimulates investment and competition, and the impact of JKN on specific priority health areas and the efficiency and quality of how healthcare resources are used.
HP+ partnered with the National Team for the Acceleration of Poverty Reduction, known as TNP2K, and other actors within the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers the impact of JKN from four perspectives—the payer, patient, provider, and private sector—and:
Analyzes JKN's long-term financial sustainability and the public sector fiscal space to finance JKN in the context of rising spending under the scheme
Measures JKN's influence on household health-seeking behavior, particularly among poor and near-poor individuals
Assesses JKN's influence on access to key health services, including maternal and neonatal health, family planning, tuberculosis, and HIV
Captures JKN's impact on private health providers' investment decisions, competitiveness, and the efficiency of healthcare service delivery
Considers the impact on the private health market overall and association with labor market gains
Comprehensive Assessment of Indonesia’s National Health Insurance Scheme
The central purpose of Indonesia’s national health insurance scheme is to address existing inequities in access to and quality of healthcare, ensuring that all citizens, especially the poor and near-poor, can access quality care without facing financial hardship. Is it working?
Indonesia’s national health insurance scheme is one of the most ambitious single-payer programs in the world. The government is committed to ensuring JKN’s ongoing sustainability, but how can it improve the predictability of its outlays to the scheme?
Has Indonesia’s national health insurance scheme improved family planning use and access to maternal and newborn health services and HIV care and treatment?
Responding to the demand for health services created through Indonesia’s national health insurance scheme will require strong partnership between the government and the private health sector. Do JKN processes support the private health sector remaining robust and continuing to invest and grow?
Results from the JKN comprehensive assessment were presented at nearly 20 forums over 2017–2018, including diverse consultations with government, private sector, implementing partner, and donor representatives and at the following conferences:
The financial sustainability model, in particular, helped inform government decision making around the timing and feasibility of increases to premium contributions under the scheme.
Post assessment, HP+ is continuing to share results of the assessment and support the Government of Indonesia to improve maternal and newborn health outcomes and strengthen HIV prevention and treatment cascades through evidence generation, capacity development, and advocacy.
HP+ Blog Outlines How to Accelerate HIV Epidemic Control in Indonesia
December 2020 —
Last week, in conjunction with World AIDS Day, HP+ published a blog outlining recommendations detailing how Indonesia can accelerate its advancement toward HIV epidemic control. Based on their technical assistance experience, the authors explain how changes to service delivery models, populations targeted, and payment mechanisms can reduce costs while improving HIV-related outcomes. The blog was first published by the Infectious Diseases Society of America’s Science Speaks Blog and later cross-posted on Viewpoints.
Indonesia Launches Improved Planning and Budgeting Platform to Advance Minimum Service Standards in Health
December 2020 —
HP+ is supporting the Government of Indonesia to advance subnational performance geared toward achieving the Minimum Service Standards in Health (SPM) for 12 primary healthcare services, including services for pregnant women, delivering mothers, and newborns, as well as family planning education and services. In partnership with PPJK, HP+ improved the planning and budgeting platform for SPM by decreasing complexity of the user interface, designing an error detection system to identify cost outliers and improve data collection from primary healthcare facilities, and enabling the platform to be interoperable with other information systems. HP+ also supported the development of e-learning modules, which are critical to the successful national rollout of the revised platform. The improved platform will equip district health officials across the archipelago with the budgeting and planning tools needed to estimate resources required to achieve SPM targets and improve allocation of resources for health to achieve better health outcomes. The revised platform was officially launched this week in Jakarta by the Secretary General of the Ministry of Health for all 514 districts across Indonesia.
Public-Private Partnerships for Health: Nuts and Bolts from Policy to Practice – Highlights from India
November 2020 —
On November 12, HP+, in conjunction with USAID and Indonesia’s Ministry of Health’s Centre for Health Financing and Insurance (PPJK), hosted a global practice webinar. “Public-Private Partnerships (PPPs) for Health: Nuts and Bolts from Policy to Practice—Highlights from India” is the fourth webinar in a series focused on strengthening health sector stakeholders’ understanding of global best practices in scaling up high-quality health services through PPPs. With over 100 participants hailing from government, academia, and the private sector, the webinar explored the rationale and benefits for creating PPPs, approaches to identifying opportunities for collaboration, and the tools, resources, and institutions necessary to design and implement partnership approaches. Examples were taken from India’s experience in expanding private sector engagement and blended financing mechanisms in pursuit of better health outcomes, including the Utkrisht Development Impact Bond model applied to maternal and newborn health programs. Speakers, who included representatives from PPJK, the Gates Foundation, USAID/Washington, and USAID/Indonesia, inspired the audience to think beyond traditional corporate social responsibility, toward innovative ways to harness new collaborations between the public and private sectors.
Strengthening Local Government Planning and Budgeting for Essential Health Services in Indonesia
September 2020 —
HP+ conducted a costing study in 24 districts across the five major island groups in Indonesia to support the government to implement minimum service standards (SPM) for 12 primary healthcare services. Data from the study has been used to improve existing SPM budgeting and planning tools used by local governments. This will alleviate administrative burdens on districts and support 514 district health offices in better planning to achieve SPM targets by improving allocation of resources for health. HP+ is providing virtual technical assistance on use of the tools and will develop e-modules to strengthen local government capacity to use them.
Webinar Features Fiscal Space Analyses of Indonesia and the Philippines
August 2020 —
Since the emergence of COVID-19, the debate on whether health should be re-prioritized in government budgets with explicit allocations and earmarks has re-emerged. On July 27, an HP+ webinar featured recent analyses of fiscal space for health conducted by USAID’s ProtectHealth project in the Philippines and HP+ in Indonesia. In “Fiscal Space for Health in the Era of COVID-19: Constraints and Choices in Preserving Gains for Indonesia and the Philippines,” speakers—including high-level finance ministry officials from both countries—highlighted current fiscal constraints, government budgetary responses to the COVID-19 crunch on revenues, and possible avenues through which additional financing could be raised.
Can Decentralization Accelerate Countries’ Journey to Self-Reliance?
August 2020 —
Why do countries decide to decentralize their health sectors? What challenges do they face in assigning functions appropriately and agreeing on stewardship roles? Does financing follow function? An HP+ webinar on July 29 tackled these complex questions and more. Featuring the experiences of two countries that have engaged in large-scale attempts at decentralization of health sector financing and governance—Kenya and Indonesia—“Health Sector Decentralization: Can it Still Deliver?” focused on the essential question of whether decentralization can accelerate countries’ journeys to self-reliance. Among the presenters was Meral Karan, a Senior Governance Adviser at the Center of Excellence on Democracy, Human Rights, and Governance.
AIDS2020 Virtual Satellite Session Showcases the Role of Data in Improving HIV Service Delivery
July 2020 —
A virtual satellite session—"Data Matters: The Role of Local Stakeholders and Data in Influencing HIV Services and Programs”—was held on July 8, as part of AIDS2020. The session showcased how HIV service delivery is improved when stakeholders generate and use local evidence and data to inform community-level programs. Representatives from the International Treatment Preparedness Coalition joined Palladium and HP+ colleagues Ron MacInnis and Ratna Soehoed, who discussed the use of province-level cost and epidemiological data for HIV planning and budgeting in Jakarta, Indonesia. A recording of the session will be available to the general public next week.
Journal Article on Cost Delivery Services in Indonesia Published
July 2020 —
HP+ Indonesia’s partnership with Badan Litbangkes has resulted in a second article being accepted in the journal PlosOne. “The Influence of Jaminan Kesehatan Nasional (JKN) on the Cost of Delivery Services in Indonesia” aimed to identify the association between use of Indonesia’s national health insurance (JKN) and out-of-pocket expenditures in accessing delivery services. The study found that use of JKN is associated with reduced out-of-pocket expenditures for delivery as well as reduced risk of incurring catastrophic delivery expenditure, though some out-of-pocket expenditures for delivery services still exist among mothers enrolled in the scheme.
Indonesia Public-Private Partnership Technical Guidelines Move Forward
July 2020 —
Indonesia’s Secretary General of the Ministry of Health expressed support for the swift adoption of new technical guidelines on public-private partnerships (PPPs) and encouraged national and subnational stakeholders to engage in implementation and budgeting for the new guidelines. HP+ has been working with the Indonesian government to develop a blueprint for how to engage in PPPs in non-infrastructure endeavors, such as the training of healthcare workers, management of healthcare facilities, and community-based prevention and promotion activities. The guidelines, which apply to the whole health sector, will soon be finalized and presented to Ministry of Health leadership for adoption.
HP+ Uses Assessment Tools to Strengthen Indonesian Health Care Referral Company
May 2020 —
In March, HP+ conducted a strategic planning and business viability assessment for SijariEMAS Teknologi Inovasi (PT STI)—an information and communication technology private sector start-up focused on improving health sector referrals for pregnant mothers and newborns in Indonesia—using an adaptation of Palladium’s Strategy Execution Bootcamp. As a result of the assessment, the start-up was able to successfully identify key areas to strengthen. HP+ will continue to support PT STI to make strategic adjustments regarding scale-up and expansion of the referral network to new districts, improve marketing and pricing strategies, streamline procurement and contracting processes, and diversify resources.
Journal Article on Influence of Pregnancy Classes on Maternal Health Services in Indonesia Published in BMC Public Health
March 2020 —
This month, HP+ supported researchers from Indonesia’s National Institute for Health Research and Development (Balitbangkes) to publish a journal article in BMC Public Health. HP+ strengthened capacities of the researchers to analyze data about potential risk factors for adverse maternal and newborn health (MNH) outcomes and write and submit five academic articles to peer-reviewed journals. Balitbangkes’ research will contribute to the dissemination of MNH scholarship among learned communities, inform a wide audience beyond technical subject-area experts about key MNH risk factors in Indonesia, and support the development of informed decisions by policymakers.
2020 Prince Mahidol Award Conference
February 2020 —
Representatives from HP+ Cambodia and Indonesia teams participated in the Prince Mahidol Award Conference 2020, adding to discussions on universal health coverage with case studies on HIV financing, social protection, and private sector engagement. HP+ collaborated with USAID to host a well-attended satellite session entitled Harnessing the Private Sector for UHC through Smart Policy, with participation by Elaine Menotti and Pellavi Sharma of the Office of Population and Reproductive Health.
HP+ Disseminates Subnational HIV Cost Results in Jakarta
November 2018 —
On October 10, in Jakarta, HP+ disseminated cost results from its subnational HIV activity to an audience of more than 50, composed of attendees from the Indonesian government, civil society, and development partners. HP+ collected primary cost data from 19 civil society organizations and “puskesmas” (community health clinics) in Jakarta to identify the unit costs of delivering critical HIV interventions, disaggregated by key population reached and service delivery model. Detailed, updated unit costs are needed to improve estimates of the total resources required to meet provincial HIV targets and to explore the feasibility of increased financing of the HIV response through local government and greater integration into the Jaminan Kesehatan Nasional benefits package—the country's single-payer national health insurance scheme. As a result, the Provincial Health Office for Jakarta, which presented at the dissemination event, committed to using HP+ cost results in its annual budgeting and planning for HIV activities.
Strengthening Financial Sustainability of Indonesia’s National Health Insurance Scheme
October 2018 —
Indonesia's MoF and other ministries have an interest in understanding whether Indonesia’s national health insurance scheme—Jaminan Kesehatan Nasional (JKN) - delivers a positive and equitable impact on Indonesian’s health and welfare. HP+ worked with the MoF to design a M&E framework for health and with the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers JKN’s long-term financial sustainability and the impact of JKN from various perspectives, including on private health providers' investment decisions, competitiveness, the efficiency of healthcare service delivery, and the impact on the private health market overall, including labor gains. These findings are being used to inform continued investment in JKN and changes to the legal framework for health in the country. In October, HP+ was recognized for ‘Excellence in the Use of Theory of Change’ by the USAID Mission in Indonesia for their work on the JKN comprehensive assessment.
