The document discusses telemedicine in the implementation of health services in Indonesia. It provides background on the author and outlines the spectrum of health services from primary prevention to tertiary prevention. It discusses regulations around public and private health services and how different services are financed. The document uses examples of managing hypertension, diabetes, and pregnancy/delivery to illustrate levels of prevention and how services are coordinated. It compares public health services and standards to private health insurance services. The document discusses current and potential roles of telemedicine and issues around integrating telemedicine with in-person services and coordinating public and private telemedicine. It proposes solutions like electronic health records, stepped implementation, and regulatory revisions.

1. Telemedisin dalam Pelaksanaan
Pelayanan Kesehatandi Indonesia
Purnawan Junadi, ATENSI July 2022

2. Background
• MD in FKUI (1978)
• PhD in Urban Planning in U of M (1987)
• Professor in FKMUI (retired)
• Chairman of Indonesian Telemedicine
Association (ATENSI)
• Chairman of Indonesian Society on
Antiaging Wellness Aesthetics and
Regenerative Medicine (PERDAWERI)
• Chairman of Indonesian Community
Functional Advancement of Medicine
(ICFAM)
• Secretary of KDI ( Indonesian Medical
College)

3. Spectrum of Health Services (HS)
Primary
Prevention
Health
Promotion
Specific
Protection
Secondary
Prevention
Early
Diagnosis and
Prompt
Treatment
Tertiary
Prevention
Disability
Limitation
Rehabilitation
Preventive Curative

4. Regulation of “IHS”
(Govt Reg no 72, 2012)
Preventive Curative
Private Health
Services
article 172:
Business of Medical
Care
Public health good
article 179:
Business of Disease
Prevention
Social Insurance
article 115/177
Central govt
Poor and isolated
art 114/176
District Govt
art 114

5. Pelayanan Publik adalah tanggung jawab
Negara
Non Excludable Non Rivalry: Promosi kesehatan, perlindungan khusus : Sanitasi
Externalitas: Imunisasi dan skrining/deteksi dini, Penanganan Penyakit Menular : TB
Market Failures: TB/HIV, DM/Hipertensi
Komitmen Global/ Global Public Goods: Penanganan HIV
Nation Survival: “Children As Public Good”: Yankes terkait kehamilan/persalinan/kesehatan
bayi dan balita
• Pelayanan Publik Bidang Kesehatan

6. C o ncu rrent A u tho ritie s
Optional (12:3)
1. Marine and
fisheries;
2. Tourism;
3. Agriculture;
4. Forestry;
5. Energy and
mineral
resources;
6. Trading;
7. Industry; and
8. Transmigration.
1. Education;
2.Health;
3. Public Utilities;
4. Public Houses;
5. Public safety &
security;
6. Social Work;
Obligatory
1. Spatial planning;
2. Living environment;
3. Food security;
4. Population administration and civil
registration;
5. Population and family planning control;
6. Transportation;
7. Labor;
8. Land;
9. Communications and informatics;
10. Cooperatives, small and medium
enterprises;
11. Capital investment;
12. Youth and sport;
13. Village community empowerment;
14. Empowerment of child protection women;
15. Statistics;
16. Encryption;
17. Culture;
18. Library; and
19. State archives.
Not Basic (12:2)
Basic Services(!2:1)
Kesempatan 2014: Kesehatan menjadi wajib
6
SPM

7. IHS in practice: Who finance the activities?
Preventive Curative
Pelayanan Kesehatan
Perorangan
Article 172: Fokus
Pengobata
Pelayanan Kesehatan
Masyarakat
Article 179: Fokus
Peningkatan Kesehatan dan
Pencegahan
Sosial
Insurance and
BPJS Law:
Premium
Poor people:
National Budget
State and Nat
Budget
OOP
State Budget
Poor states:
National budget
JKN: National health Insurance
SPM: min care Standard

8. OOP
Sosial
Insurance and
BPJS Law:
Premium
Poor people:
National Budget
Example : Hypertension and Diabetes Mellitus
Primary
Prevention
Healthy live
infor
Reg on salt
and sugar
Secondary
Prevention
Mass MCU
Chronic dis
Mgt
(Prolanis)
Tertiary
Prevention
Stent/
bypass op
Stroke
management
State Budget
Poor states:
National budget

9. Example: Pregnant and Delivery
Primary
Prevention
Reproductive
health info
Adolescent
Health
Reg on
Marrital Age
Secondary
Prevention
ANC,
Delivery
& PNC
ANC,
Delivery
& PNC
Tertiary
Prevention
Sectio
& other OP
HPP
Sosial
Insurance and
BPJS Law:
Premium
Poor people:
National Budget
OOP
State Budget
Poor states:
National budget
How to coordinate /avoid duplication?

10. Differences of Public and Private IHS
1. Life cycle group/mass
promotion
2. Mass / group
immunization
3. Mass screening
4. Early detection
5. Early treatment of public
health diseases
• PH Services /SPM • Private Services/JKN
1. Personal education
2. Individual immunization
3. Health screening
4. Detection and treatment
5. Rehabilitative care

11. Managerial aspect of IHS
1. Arranger: District Govt
(regulate by MOH)
2. Main Executor: District
Govt
3. Can delegate services to
appropriate private player
4. Payer: Regional govt,
subsidized by MOH if
insufficient/poor districts
5. Cost: at Cost
• SPM: Minimal Services Standard
• Focus: Make People Healthy
• JKN: National Health Insurance
• Focus: Effective and Efficient Care
1. Arranger: BPJS
2. Main Executor: Private health
facilities!
3. Can be conducted by govt
4. Payer: individual/company,
and govt for the poor (Govt
responsibility)
5. Cost: Capitation and Ina CBG
(managed care)

12. SPM is a life cycle approach
(MOH reg no 4/2019)
• Provincial Health SPM
1. Health Services Due To Disasters
2. Health Services In Extraordinary Events/ Outbreak
• District / City Regional Health SPM :
1. Health Services For Pregnant Women;
2. Maternity Health Services;
3. Newborn Baby Health Services;
4. Toddler Health Services;
5. Health Services At The Age Of Primary Education;
6. Health Services At Productive Age;
7. Health Services In The Elderly;
8. Health Services For Patients With Hypertension;
9. Health Services For People With Diabetes Mellitus;
10. Health Services For People With Severe Mental
Disorders;
11. Health Services For People Suspected Of TBC
12. Health Services For People At Risk Of HIV

13. Current Role Of Telemedicine
(based on Cases on Pandemic)
Preventive Curative
BPJS Experiments
Gov Experiments
OOP
JKN
B to B
Insurance
CSR
APBN

14. Possible Development of Telemedicine Roles in HIS
PH Services /SPM
1. Life cycle group/mass
promotion
2. Mass / group immunization
3. Mass screening
4. Early detection
5. Early treatment of public
health diseases
Private Services/JKN
1. Personal education
2. Individual immunization
3. Health screening
4. Detection and treatment (tech
advancement)
5. Rehabilitative care (chronic,
home care,

15. FKTP
PLT
c
c
FKTL
Patient
Customer
? ?
ADDING PLT ON IHS : REACH MORE, COST
LESS
Fasyanke
s
Fisik
PSE/Fasyank
es
Virtual

16. Isyu dan solusi Pengembangan IHS
1. SPM belum berjalan
• Memerlukan Data Kohort. Solusi: e-HR
• Pelayanan Proactive memerlukan data Keluarga. Solusi: e-HR (Family
linkage)
• Dana APBD “tidak “ cukup*. Solusi: pelaksanaan bertahap, DAK untuk SPM
2. Integrasi Telemedisin dengan pelayanan tatap muka
• Data Integrasi. Solusi: e-HR
• Isyu Regulasi. Solusi: revisi PMK 20 th 2019/ Sandbox Regulation
3. Koordinasi PLT (swasta) dengan IHS
• Data integrasi. Solusi: e-HR
• Koordinasi Pendanaan. Solusi: skema Pembiayaan dan Insentif

17. Anggota Kami