Indonesia : Health Delivery and Financing Sys


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Indonesia : Health Delivery and Financing Sys

  1. 1. IndonesiaHealth Delivery System and Health Financing SystemDeni Iskandar (201221264) # 人間総合科学研究科 # フロンティア医科学専攻 # 保健医療政策学分野
  2. 2. Quick Facts Infant Mortality Rate : 34 per 1,000 live births (2007) Maternal Mortality Rate: 228 per Annual Parasite Incidence : 1.85 (2009) 100,000 live births (2007) Annual Malaria Incidence : 10.59 (2009) Life expectancy : 69.43 years (2010) TB Case Detection Rate : 73.1 Crude Death Rate : 3.96 per 1,000 TB Success Rate : 91 population (2007) Dengue Hemorrhagic Fever Incidence : Total Fertility Rate : 2.177 (2007) 68.22 per 100,000 population People with AIDS : 19,973 cases (2009) Acute Flaccid Paralysis : Cumulative Case 1,691 (2009); non polio AFP 2.67 per 100,000 population under 15 Mal- and Under-nutrition Filariasis : 11,914 cases (2009)
  3. 3. National Health SystemUndang Undang Dasar 1945 (1945 Constitution) “Each person has a right to a life of well-being in body and mind, to a place to dwell, to enjoy a good and healthy environment, and to receive medical care” “The state (country) has the responsibility to provide proper medical and public service facilities”The Law Act No. 17 of 2007 on the Long-term National Development Plan 2005-2025The Law Act No. 23 of 1993 on Health (the latest is No. 36 of 2009)The Law Act No. 25 of 2004 on National Development Plan SystemThe Law Act No. 32 of 2004 on Local Government 1982 Guideline for central government, local government and society in health development activity Decree of Minister of Health of The Republic of Indonesia. No. 374/MENKES/SK/V/2009 2004 2009 National Health System Legal Aspect
  4. 4. National Health System Health Improvement Health Financing Human Resources Pharmaceutical, Medical Device and Food Health Management and Information Community Empowerment Sub-system
  5. 5. Health Delivery SystemHealth Financing System
  6. 6. Health Delivery System Primary Health Service - Primary Personal Health Service - Primary Public Health Service Secondary Health Service - Secondary Personal Health Service - Secondary Public Health Service Tertiary Health Service - Tertiary Personal Health Service - Tertiary Public Health Service Service Level
  7. 7. Health Delivery SystemPersonal Health Service Referral Public Health Service Referral Hospital: public/specialized Department of Health Central / Province Tertiary Provincial health department Hospital: public/specialized, Regency/ Regency/city health department, City, BP4, BKMM, private specialist BP4, BKMM, BKKM clinic, private specialist medical Secondary practice, Private medical practice (family community health center doctor), community health center, Primaryclinic, BKIA, private midwife practice Posyandu, polindes Public UKBM: Posyandu, polindes, other Self family health effort Health cadre, Self Personal / Family family health effort Referral System
  8. 8. Health Delivery System Department of Health Ministry of Health Central Level Provincial Health Office Province Level District Health Office District Level Community Health Center Sub-district Level Auxiliary Community Health Center POLINDES POSYANDU Sub health center Organizational Structure of Health System
  9. 9. Health Delivery System Healthcare System Public Private Puskesmas Specialty General MOH Provincial District Private Pustus and Private PrivateHospital Hospital Hospital Clinics Mobile Hospital Hospital Clinics Infrastructure
  10. 10. Health Delivery System Hospital Public Private Ministry of Health/ Police/Armed Other Ministry Private Private BUMN District Government Force Non- profit General / Specialized Hospital (by administrator)
  11. 11. Health Delivery System Class A (>400 beds) = Extensive specialist medical services 10 + extensive sub specialists Public Hospital Class B (100-400 beds) Extensive specialist medical services = 120 + limited sub specialists Has minimum of four basic specialist Class C (50-100 beds) medical = 250 servicesHospitals (General and Specialty) Class D (<50 beds) = Provides basic medical facilities 126 General medical services + specialists Priority and sub-specialists Private Hospital Minimum four specialists medical Madya services Pratama General medical service Hospital (by class)
  12. 12. Health Delivery System Number of Beds by Hospital Ownership
  13. 13. Health Delivery System Hospital Classification by Type Hospital Classification by Specialty Percent of Hospitals by Type and Percent of Specialist Hospitals Sector, Indonesia, 2010 Split by Specialty, Indonesia, 2010 Public (Military) Mental 15.3% Leprosy 8% 6.6% Public Pulmonary (Ministry of Others TB Health) 19.5% 3.0% Public (State 36% or other govt dept-owned) 5% Eye 3.9% Maternity 19.5% Pediatric Private 32.1% 51% Hospital Distribution
  14. 14. Health Delivery System Aceh No. of hospitals: Hospitals are concentrated in major cities in the Sumatra 35 and Java province, such as Jakarta, Surabaya, Medan. Sumatra Selatan No. of hospitals: 34Sumatra Utara Jawa BaratNo. of hospitals: No. of hospitals: 130 144 Jawa Timur No. of hospitals: 171 Sulawesi Selatan No. of hospitals: Sumatra Barat 62 No. of hospitals: 41 DKI Jakarta Jawa Tengah Bali No. of hospitals: No. of hospitals: No. of hospitals: 124 162 34 Distribution
  15. 15. Health Delivery System Ratio Puskesmas per 100,000 Population Puskesmas
  16. 16. Health Delivery System Strong points - Established primary health care network Weak points - Under-funded healthcare facilities - Lack of adequate primary care coverage - Decentralized system makes it difficult to be synchronized with other - Some are not properly managed
  17. 17. Health Financing System Insurance System
  18. 18. Health Financing System Strong points - Preparation for universal coverage system - Insurance for the poor Weak points - Low coverage for free/low cost healthcare. Insurance System
  19. 19. Thank You . . .