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Kalsum Komaryani_The Latest Figure of NHA.pdf

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Kalsum Komaryani_The Latest Figure of NHA.pdf

  1. 1. The Latest Figure of NHA dr. Kalsum Komaryani, MPPM Director of Centre for Health Financing and National Health Insurance Ministry of Health, Republic of Indonesia Jakarta, 21 September 2021
  2. 2. National Health System (Presidential decree No.72/2012) Health Effort on Personal and Community 01 02 04 05 03 06 07 Research and Development on Health Health Financing Health Workforce Pharmaceutical, medical devices and food supply Management, information and regulation on health Community empowerment
  3. 3. Health Financing Goal Health financing aims to provide sustainable health financing in sufficient amounts, allocated fairly, and utilized effectively and efficiently to ensure the implementation of health development in order to increase the health status of the community as high as possible (Article 170, Law 36/2009). Sufficient and sustainable financing Fair allocation Effective and efficient spending
  4. 4. Financing Sources Government APBN Households Donor Private Allocated, among others, for: • JKN contribution • Private health insurance premium • Over the counter medicines • Medical check-up • health care (eg: vitamins) Aids for health programme such as HIV/AIDS, TB, MNH, malaria, nutrition, health system strengthening, pandemic responses, health workforce, etc Allocated, among others, for: • JKN contribution • Private health insurance premium • Direct employee arrangements related to health (eg: reimbusement, medical allowances) • Company clinics • infrastructure • Information system Allocated, among others, for: • Public health efforts in MoH & other govt institutions • JKN contribution for subsidized members • Regional health fund transfers (DAK) • Health administration • Information system • Health services delivery in other govt institutions APBD Allocated, among others, for: • Public health efforts in provincial and district level • JKN contribution for subsidized members accding to Presidential Decree 64/2020 • Infrastructure • Operational cost • Health administration • Information system
  5. 5. Allocation Public Health Efforts (UKM) Personal Health Care Efforts (UKP) Promotive and preventive services Curative and rehabilitative services Infrastructure and Administrative Supply side financed through JKN (National Health Insurance) system, additional voluntary health insurance allowed financed through central and local government health budgets
  6. 6. NHA definition A systematic and comprehensive tracking of the flow of funds in a country's health system for a period of one year National purpose As a tool to monitor activity indicator performance in the Strategic Plan of the Ministry of Health, namely : "Development of Health Financing and Insurance" with the aim of producing technical policy input for the development of health financing and JKN. One of the activity indicators is “National Health Account (NHA) document produced”  Global Health Expenditure Database (GHED) provides health expenditure data from 190 WHO member countries.  WHO works closely with member countries to update the database annually. 01 02 International purpose NHA use as a strategic tool for country’s health system monitoring from a consumption perspective
  7. 7. NHA Dimensions Principle: CONSUMPTION = PROVISION = FINANCING Total Health Expenditures: Current spending + Capital formation Core Accounting Framework Health Provision Health Financing Healthcare Consumption Extended Dimension: Beneficiaries (HB) [Disease, age, sex, etc.] Core Dimension: Healthcare Function (HC) Core Dimension: Financing Scheme (HF) Extended Dimension: Core Dimension: Healthcare Provider (HP) Extended Dimension: Financing Agent (FA) Revenue of Financing sources (FS) Factor of Provision (FP) Capital Formation (HK)
  8. 8.  Identifying data  Developing database  Data entry  Data cleaning  Identifying Double counting  Translating the data into SHA 2011 dimensions  Disaggregation process  Developing data template required  Requesting data from several institutions  Conducting the survey  Downloading the data from accessible website  Analysis for national and international needs  Discussion for result analysis to stakeholders that provide the data  Obtaining the same understanding between NHA team and the stakeholders  Dissemination  Workshop  Publication www.ppjk.kemkes.go.id NHA Production in Indonesia: Stages and Process 01 02 04 Data Collection 03 Data Management Result & Endorsement Analysis & Triangulation
  9. 9. Indonesia Health Spending, 2019 National Health Insurance (JKN) IDR 112,1 Trillion Work Accident Security (JKK)* IDR 1,2 Trillion Private Schemes** IDR 77,3 Trillion 15,8% OOP Scheme IDR 157,5 Trillion 32,1% MoH Scheme IDR 21,1 Trillion 4,3% Other Ministries Schemes IDR 9,5 Trillion 1,9% Subnational Schemes IDR 111,6 Trillion 22,8% SHI Schemes IDR 113.3 Trillion 23,1% Total Health Expenditure 2019 IDR 490,3 Trillion Public Schemes IDR 255,5 Trillion (52,1%) Non-Public Schemes IDR 234,5T Trillion (47,9%) Data Source: NHA Indonesia 2019 Notes: *JKK is only accounted for health services and treatment due to work accident **including private health insurance, corporations, NPISH
  10. 10. 0.00 50.00 100.00 150.00 200.00 250.00 300.00 350.00 400.00 450.00 500.00 2012 2013 2014 2015 2016 2017 2018 2019 4.7% 5.0% 4.7% 5.6% 5.8% 4.7% 4.7% 4.3% 1.6% 1.7% 1.3% 2.2% 2.3% 1.9% 2.1% 1.9% 16.4% 17.3% 16.7% 17.7% 21.5% 21.6% 22.2% 22.8% 6.7% 8.4% 14.7% 17.6% 19.3% 22.2% 22.8% 23.1% 2.5% 3.4% 3.2% 2.8% 3.0% 3.2% 3.1% 3.5% 0.8% 0.7% 0.7% 0.9% 1.1% 1.1% 1.1% 1.2% 15.7% 15.0% 15.1% 12.9% 11.3% 11.6% 11.0% 11.1% 51.6% 48.5% 43.7% 40.2% 35.8% 33.7% 33.0% 32.1% Rp Trillion MoH Other Ministries Subnational Social Health Insurance Private Health Insurance NPISH Corporation Households' OOP 260.7 287.5 324.6 358.3 399.3 423.9 454.1 490.3 Rp 255,5 T (52,1%) Rp 234,8 T (47,9%) Non-public Schemes Public Schemes Indonesia Health Expenditure, 2012 – 2019 Rp Trillion 0 50 100 150 200 250 300 350 400 2012 2013 2014 2015 2016 2017 2018 2019 4.7% 5.0% 4.7% 5.6% 5.8% 4.7% 4.7% 4.3% 1.6% 1.7% 1.3% 2.2% 2.3% 1.9% 2.1% 1.9% 16.4% 17.3% 16.7% 17.7% 21.5% 21.6% 22.2% 22.8% 6.7% 8.4% 14.7% 17.6% 19.3% 22.2% 22.8% 23.1% 2.5% 3.4% 3.2% 2.8% 3.0% 3.2% 3.1% 3.5% 0.8% 0.7% 0.7% 0.9% 1.1% 1.1% 1.1% 1.2% 15.7% 15.0% 15.1% 12.9% 11.3% 11.6% 11.0% 11.1% 51.6% 48.5% 43.7% 40.2% 35.8% 33.7% 33.0% 32.1% Total Health Expenditure (Constant)* Skema Kemenkes Skema K/L lain Skema Pemda Skema Askes Sosial Skema Askes Swasta LNPRT Korporasi Skema Pembiayaan RT 260.7 273.9 293.3 311.4 338.7 344.8 355.8 378.0 *Baseline: constant prices in 2012 Constant prices are used to determine economic growth by using prices in a certain year as a basis (revaluation of inflation) Data Source: NHA Indonesia 2019
  11. 11. *Baseline: constant prices in 2012 1,287 1,403 1,544 1,619 1,714 1,829 77 109 124 106 117 115 215 249 332 349 381 416 357 403 449 500 498 505 - 150 300 450 600 750 900 1,050 1,200 1,350 1,500 1,650 1,800 1,950 2014 2015 2016 2017 2018 2019 In Thousands (Rupiah) Health Expenditure per Capita (In real/current prices) Total Belanja Kesehatan Pemerintah Pusat Pemda Askesos Total Health Expenditure Central Government Local Government Social Health Insurance 1,163 1,219 1,309 1,316 1,342 1,410 70 95 105 86 91 88 194 216 281 284 298 321 323 350 381 406 390 390 - 150 300 450 600 750 900 1,050 1,200 1,350 1,500 1,650 1,800 1,950 2014 2015 2016 2017 2018 2019 In Thousands (Rupiah) Health Expenditure per Capita (In constant prices)* Total Belanja Kesehatan Pemerintah Pusat Pemda Askesos Total Health Expenditure Local Government Central Government Social Health Insurance Health Expenditure per Capita in Indonesia, 2014-2019 Data Source: NHA Indonesia 2019
  12. 12. Share of Total Health Expenditure as GDP Indonesia: stagnant 2.00 2.2 3.00 3.8 3.7 3.5 4.5 2.8 6.7 7.4 2.5 2.6 3.1 3.8 3.9 4.5 4.6 5.1 5.9 6.6 .00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 % Total Health Expenditure as GDP, 2012 & 2018 2012 2018 2.1 1.9 2.9 3.5 3.5 4.4 3.3 2.4 6.3 7.3 2.2 2.4 2.9 3.8 3.8 4.4 4.5 4.8 5.9 06 Current Health Expenditure* as GDP, 2012 & 2018 2012 2018 *not included capital expenditure Data Source: NHA MoH Indonesia and Global Health Expenditure Database-WHO
  13. 13. Share of Public Schemes per GDP (%) 0.4 0.7 0.9 1.2 1.7 1.9 1.7 1.5 2.8 2.8 0.8 1.1 1.4 1.5 1.6 1.9 2.3 2.5 2.8 3.00 Current Health Expenditure* as GDP in Public Schemes, 2012 & 2018 2012 2018 0.8 0.9 1.00 1.3 1.9 2.1 1.8 1.7 3.2 3.1 1.1 1.5 1.7 1.7 2.1 2.1 2.4 2.5 2.8 3.00 Total Health Expenditure as GDP in Public Schemes, 2012 & 2018 2012 2018 *not included capital expenditure Data Source: NHA MoH Indonesia and Global Health Expenditure Database-WHO
  14. 14. Indonesian Health Expenditure by Revenue of Financing Schemes, 2019 Total Health Expenditure 2019 490,3 T Public 255,5 T (52,1%) Non-Public 234,8 T (47,9%) MoH Scheme 21,1 T (4,3%) Other Ministries Scheme 9,5 T (1,9%) Subnational Schemes 111,6 T (22,8%) Social Health Insurance Scheme 113,3 T (23,1%) Households’ OOP Scheme 157,5 T (32,1%) Other Non-public 77,3 T (15,8%) Central Government 19,0 T (89,99%) Donor 2,1 T (10,01%) Provincial Government 12,4 T (11,1%) District/City Goverment 9,7 T (8,7%) Corporates 24,3 T (21,4%) Households 28,8 T (25,4%) Households 157,5 T (100%) Corporates 68,0 T (88,1%) Households 6,7 T (8,7%) District/City Goverment 1,7 T (2,3%) Donor 470,3 M (0,6%) NPISH 307,2 M (0,4%) Central Government 89,5 T (80,2%) Central Government 9,5 T (99,8%) Donor 14,5 M (0,2%) Provincial Government 2,7 T (2,3%) District/City Goverment 10,4 T (9,2%) Central Government 47,1 T (41,7%) District/City Goverrnment, 4.5% Provincial Government, 3.1% Central Government, 33.7% Donor, 0.5% NPISH, 0.1% Corporates, 18.8% Households, 39.4% Data Source: NHA Indonesia 2019
  15. 15. Indonesian Health Expenditure by Healthcare Function, 2019 Total Health Expenditure 2019 490,3 T Public 255,5 T (52,1%) Non-Public 234,8 T (47,9%) MoH Scheme Rp 21,1 T Other Ministries Scheme Rp 9,5 T Subnational Scheme Rp 111,6 T Social Health Insurance Scheme Rp 113,3 T Households’ OOP Scheme Rp 157,5 T Other Non-public Scheme Rp 77,3 T In-patient curative Rp 2,5 T (12%) Out-patient curative Rp 2,5 T (12%) Preventive care Rp 7,6 T (36%) Governance Administration Rp 2,5 T (12%) Capital Rp 6,0 T (28%) In-patient curative Rp 1,5 T (16%) Out-patient curative Rp 2,4 T (25%) Preventive care Rp 2,6 T (28%) Governance Administration Rp 1,6 T (16%) Capital Rp 1,4 T (15%) In-patient curative Rp 18,6 T (17%) Out-patient curative Rp 26,5 T (24%) Preventive care Rp 34,0 T (31%) Governance Administration Rp 10,2 T (9%) Capital Rp 22,3 T (19%) In-patient curative Rp 60,8 T (54%) Out-patient curative Rp 42,5 T (38%) Preventive care Rp 5,1 T (4%) Governance Administration Rp 4,7 T (4%) Capital Rp 188 M (0,2%) In-patient curative Rp 34,5 T (45%) Out-patient curative Rp 28,5 T (37%) Medical Supplies Rp 3,7 T (5%) Preventive care Rp 8,0 T (10%) Governance Administration Rp 2,2 T (3%) Capital Rp 366 M (0,5%) In-patient curative Rp 59,7 T (38%) Out-patient curative Rp 46,4 T (29%) Medical Supplies Rp 25,0 (16%) Preventive care Rp 26,4 T (17%) In- patient curative 36.2% Out- patient curative 30.3% Medical Supplies 5.8% Preventive care 17.1% Governance Administration 4.3% Capital 6.2% Data Source: NHA Indonesia 2019
  16. 16. Figures of Preventive Care in Indonesia, 2019 In-patient Curative 36.22% Out-patient Curative 30.33% Medical Supplies 5.85% Governance Administration 4.32% Capital 6.19% Preventive Care 17.09% Health Expenditure by Healthcare Function, 2019 Total Health Expenditure: 490,3 T Ealry Detection 3.55% Immunization 9.17% Other Preventive Care 11.11% Healthy Condition Monitoring 43.67% KIE Programs 19.92% Epidemiological surveillance and risk and disease control 12.58% Preventive Care Spending: 83,8 T Preventive spending per capita : Rp312.603 Data Source: NHA Indonesia 2019
  17. 17. Indonesia Total Health Expenditure by Healthcare Provider, 2019 Total Health Expenditre 2019 490,3 T Public 255,5 T (52,1%) Non-Public 234,8 T (47,9%) MoH Scheme 21,1 T (4,3%) Other Ministries Scheme 9,5 T (1,9%) Subnational Scheme 111,6 T (22,8%) Social Health Insurance Scheme 113,3 T (23,1%) Households’ OOP Scheme 157,5 T (32,1%) Other Non-public Scheme 77,3 T (15.8%) FKTP 3,0 T (15,2%) Preventive & Administration Provider 9,3 T (44,2%) Hospital 5,8 T (27,3%) Related to Health Education Provider 3,0 T (14,3%) FKTP 2,7 T (27,9%) Preventive & Administration Provider 4,7 T (49,3%) Hospital 2,1 T (22,5%) Related to Health Education Provider 0,03 T (0,3%) FKTP 30,7 T (27,5%) Preventive & Administration Provider 40,5 T (36,3%) Hospital 40,4 T (36,2%) FKTP 16,5 T (14,6%) Preventive & Administration Provider 5,0 T (4,3%) Hospital 91,8 T (81,1%) FKTP 51,9 T (33,0%) Medical Goods Retailers 25,0 T (15,8%) Hospital 80,6 T (51,2%) FKTP 9,7 T (12,5%) Medical Goods Retailers 3,6 T (4,6%) Hospital 54,0 T (69,9%) Hospital 55.7% FKTP 23.7% Medical Goods Retailers 5.8% Preventive & Administration Provider 14.1% Related to Health Education Provider 0.6% Data Source: NHA Indonesia 2019
  18. 18. Improving Health Financing Public and Non Public Government Health Budget Condition: Central government has allocated more than 5% of APBN for health and regional government have reached to 10% of APBD Public and non public health expenditure 2019: public spending Rp. 255,5 T (52,1 %) non public spending Rp. 234,8 T (47,9 %) An urge to mobilize non public Health Financing Advocate; should not be seen as upper limit
  19. 19. Conclusion  NHA results have provided a comprehensive figures on health financing structures, patterns, transformations, and performance for policy makers. Despite Total Health Expenditure in nominal terms increased year by year, however share percentage as GDP was relatively stagnant. On the other hand, public spending on health has increased sharply in the last 5 years and households direct health spending (OOP) has gradually declined due to the implementation of JKN.  NHA figures is expected to be available T-1, however the required data still not supported by an information system which can be accessed automatically and available on time. Coordination, consolidation and dissemination need to be continued.  Further analysis and studies on NHA figures are required to generate better input for policy formulation. NHA combined with other data such as costing data, macroeconomic data, and health status data will produce stronger recommendations for health financing policies in Indonesia.
  20. 20. S A L A M S E H A T TERIMA KASIH S A L A M S E H A T THANK YOU @ppjk.kemkes puspjk@kemkes.go.id ppjkkemenkesri@gmail.com ppjk.kemkes.go.id

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