Rt 1 challenge and opportunity to expand health care financing on oh services in indonesia


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Presentation by dr. Hanifa M Denny, Indonesia at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

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Rt 1 challenge and opportunity to expand health care financing on oh services in indonesia

  1. 1. Challenge and opportunity to expand health care financing on OH Services for Informal and Small Scale-medium Enterprises Workers in Indonesia Hanifa M. Denny1Health insurance in IndonesiaThe government of Indonesia has started to enact health insurance program for governmentemployee/civil servant and military since 1968 based on Presidential Decree No. 230/1968.With the Decree, Ministry of Health established “Badan Penyelenggara Dana Kesehatan” orHealth Care Financing Agency. In 1992, the government changed its status from governmentagency into PT. ASKES (Persero) or Limited Liability Company owned by Government. 1 Ingeneral, PT. ASKES (Persero) provides insurance coverage for government employee/ civilservants, retired government employee/ pensioner, retired militaries and their families/military pensioner; all corporate workers; and all corporate pensioners or retired workers ; allcommunity that have paid the insurance fee by themselves or by the government. 2Another type of Health Insurance Company is PT ASABRI. PT ASABRI is the Military SocialInsurance Company, State Owned Enterprises (SOEs) that are specific to sympathize Armypersonnel, police and civil servants Members of the DoD / police in order to improve thewelfare of soldiers, police officers and civil servants DoD / police. The General Social InsuranceCompany of the Armed Forces of the Republic of Indonesia (Perum ASABRI) established underthe Government Regulation Number 45 Year 1971 on August 1, 1971, and subsequently1 Chair of the Department of Occupational Safety and Health, Post Graduate Program in Health Promotion, Diponegoro University, Semarang, Indonesia and is working on her research on Occupational Health Services for Informal Sectors in Indonesia for the Doctorate Program in Occupational Health, College of Public Health, University of South Florida, Tampa, Florida, USA and . Email: hanimd@hotmail.com; hanifadenny@mail.usf.edu
  2. 2. established as the anniversary of ASABRI. In its development efforts to improve motion, thenbased on Government Regulation Number 68 Year 1991 ASABRI establishment of the PublicCorporation (Perum) was transferred into a Limited Liability Company (PT), so that became PTASABRI (Persero). PT ASABRI is a State Owned Enterprises (SOEs) owned by the Minister forState Enterprises. 3Social Security for Indonesian WorkersNon-government employee who work in a corporate is mandated to be a member of SocialSecurity for Indonesian Workers which is managed by PT. JAMSOSTEK or other privateinsurance companies with better coverage. PT. JAMSOSTEK is a government owned LimitedLiability Company which provide social insurance for workers in private own companies. PTJamsostek (Persero) provides protection 4 (four) courses, which include the EmploymentAccident Insurance Program (JKK), Death Benefit (JK), Old Age Security (JHT) and Health Care(JPK) for the entire workforce and his family.4 The PT. Jamsostek members in 2010 hit 9.12million or 79% of its target. 5Health insurance coverage for the poor and near-poor.Indonesian government also provides health insurance coverage for the poor and near-poorthat is provide through the "Jamkesmas" program. “Jamkesmas” was initially started in 2005 asthe Askeskin (Health Insurance for the poor) was expanded in 2008 to target both the poor andnear-poor and currently targets almost a third of the population in the country. Officialestimates indicate that Jamkesmas covered almost 72 million people in 2009.Along with the implementation of autonomous region in Indonesia, there is a phenomenon thatmost of local governments have started to implement “Free Medical Service Campaign.” Thecampaign is intended to win the election to become the leader at provincial and municipalitylevels. In one side this campaign is very beneficial for health sectors as long as the localgovernment handle it effectively and efficiency. 2
  3. 3. Health Care Financing for Informal Sectors WorkersIn Indonesia, the economic backbone for microeconomics relies on workers who mostly workfor small-scale & medium enterprises and informal sectors. This population generates up to 64%of the Indonesian gross domestic product. [6] On the other hand, their awareness on safe andhealthy work practice as well as their workplace condition remains poor. [7] Workers in informalsectors are vulnerable to unsafe and poor working conditions. Unfortunately, the actualimplementation of the laws in occupational health in Indonesia does not cover the need ofoccupational health services for informal sectors.The Act on occupational health in Indonesia is stated in law No. 36 in 2009 on Health, SectionXII. This law mandates the Ministry of Health to provide health service with regard toimprovement of productivity of workers, to provide occupational health services, to preventworkers from occupational diseases and to promote workers’ health as well as to set up thestandards in Occupational Health. [8]Challenges and OpportunitiesThe Indonesian health policy mandates local government to build one health center for every30,000 inhabitants and one sub-health center for every 10,000 inhabitants. A public healthcenter has staff of at least one physician (general practitioner), several nurses and midwives,other health related personnel and administrative staff. A sub health center has at least onenurse or a midwife plus few administrative staff to provide a very basic health services to thecommunity. 9 In 2010, Indonesia had recorded 9,005 community health centers, whileIntegrated Health Posts is accounted for 266,827. Moreover, 5107 Occupational Health Posts(POS UKK) have been set up in 26 of 32 provinces in Indonesia.Our qualitative study in 2007 explored the strengths, weaknesses, opportunities, and threats(SWOT) of PUSKESMAS to implement OHIS program in Indonesia. We used open-ended 3
  4. 4. questionnaires to interview 56 government officers, 8 house members, 32 PUSKESMAS officers,128 POS UKK volunteers, 72 stakeholders and academia from 8 provinces of Sumatra and JavaIslands.We found out that the strengths of PUSKESMAS in Indonesia to provide services in OHIS werethe availability of PUSKESMASes in every sub-district; the funding from central government inOHIS; 70% of PUSKESMASes in the study had started to deliver OHIS services; availability of5107 POS UKKs; and availability of OHIS guidelines. The weakness were the limitation ofcampaign and training in OHIS; the limitation of health workers’ capabilities in OHIS services;and lack of local governments awareness on OHIS.The opportunities were the fact that informal sectors were accounted for more than 60% ofworkforce in Indonesia and numerous stakeholders as well as academia, which had beenproviding support and collaboration to serve OHIS program. The threats were the existingpolicy that put occupational health out of the “minimum services standard” required forPUSKESMAS; the uncertainty of informal sectors in their business cycles; the mobility of theworkers; and the spread out of the location informal sectors along Indonesia’s Islands. 7In conclusion, future improvement on health care financing for informal sectors and smallmedium scale of workers in Indonesia should focus on advocacy to provincial and localgovernments to expand the mechanism of health care financing system for informal sectorsand small scale-medium scale enterprises workers.Sources:1 http://www.ptaskes.com/info-perusahaan/14/Sejarah%20Singkat2 http://www.jamsostek.co.id/content/news.php?id=25843 http://www.asabri.co.id/profileperusahaan.php4 http://www.jamsostek.co.id/content/i.php?mid=25 http://www.jamsostek.co.id/content/news.php?id=15716 BPS. National Labour Force Survey 2010, Statistics Indonesia, http://dds.bps.go.id/eng/tab_sub/view.php?tabel=1&daftar=1&id_subyek=06&notab=37 Denny H, Azwar R, Purnami CT. Analisa situasi kesehatan kerja di sektor informal pada 8 Propinsi di Indonesia. Laporan kegiatan survei disampaikan ke Direktorat Bina Kesehatan 4
  5. 5. Kerja. Belum dipublikasi. (Situational Analysis of Occupational Health in Informal Sectors of 8 Provinces in Indonesia. Official survey report submitted to the Directorate of Occupational Health, Ministry of Health of Indonesia, 2007).8 Undang Undang Nomor 36, Tahun 2009 Tentang Kesehatan, Republik Indonesia. Retrieved from: http://www.pppl.depkes.go.id/_asset/_regulasi/UU_36_Tahun_2009%5B1%5D.pdf9 http://staff.ui.ac.id/internal/140163956/material/36YearsofSocialHealthInsuranceinIndonesia.pd 5