A brief description of Indonesia's healthcare landscape and the challenges it faces. The country has no choice, but to attract greater investments (also importantly, foreign investments) in capacity creation.
The Indonesia HiT reports the significant improvement in the health status of the population over the last 25 years through transitional period in all fields. However, the country faces remaining and foreseeing challenges in communicable diseases and emerging NCDs. The HiT concludes with the future challenges of expanding coverage of National health insurance scheme (JKN), reducing regional disparities in health-care services, managing resources and engaging private sector.
Health Financing for UHC – two sides of the coinHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Health access for all Thailand’s.The Thai citizens gain universal access to essential health services at zero cost, and reap significant benefits as babies get healthier, workers increase productivity, and households reduce financial risk.
Health workforce Statistics: Current Needs and Requirements
Introduction
Trained healthcare workforce is an important determinant of efficiency and outcomes of any health system as devised by WHO health systems approach. India one of the most populous country of the world has always felt a dire need of healthcare workforce even having one of the largest medical education and capacity building system. On the other hand we have a variety of health cadre namely from an ASHA to super specialized doctors. In our presentation we have critically analyzed the distribution of health workforce in India and its impacts on health and healthcare delivery for the mass of our society.
The Health Workforce in Nutshell
India faces an acute shortage of trained health workforce. India has a large basket of interventions to improve the healthcare but they are adversely effected by shortage of trained, motivated and supported health workforce. The shortages and misdistribution of health workforce have a large contribution to inequities in health outcomes. India’s health workforce is a combination of both registered, formal health-care providers and informal medical practitioners. We have a very unique health system with a large public health system and a blanket of juxtaposed private health care system. Similar situation is also present in training and education of health workforce. There is also a lack of data on the exact number of health care providers.
Issues
Quite a percentage of Indian population is spread in the rural areas but on the other hand the concentration of health care is in the urban system. The health care providers are highly concentrated in the urban area. Health worker densities are very low in rural settings when compared with urban areas. The next issue is lack of support to the health care providers practicing in the rural area and attraction of high income, support and provisions in the urban settings for the highly specialized workforce which includes doctors, dentist etc. At the national level, the aggregate density of doctors, nurses and midwives was 2.08 per 1000 population, which was lower than WHO’s critical shortage threshold of 2.28 .
Conclusion
In a concluding remark the production of health workforce has increased too many folds which has cost increased privatization of health education. On the other hand the public medical education system has not expanded at the required level. There is need to tap the potential in the private players with keep in mind stringent control of quality and cost. The increase in production is not going to resolve the issues of health worker availability and distribution. The need of the hour is to find sustainable measures to target the acute shortfall in the trained health workforce in India.
Australia has a mainly tax-funded health care system, with medical services subsidized through a universal national health insurance scheme.
some review about it.
The Australian healthcare system provides a wide range of services, from population health and prevention through to general practice and community health; emergency health services and hospital care; and rehabilitation and palliative care.
STRENGTHS & WEAKNESSES OFJAPANS' HEALTH CARE SYSTEMnaeemrsat
Japans' excellent health indicators are not entirely due to its' health delivery system. A major factor is the obsession of the Japanese for healthy life styles and food.
Also another big factor is Japans' excellent and very effective public health system
Telemedicine: An opportunity in Healthcare in IndiaAmit Bhargava
Telemedicine, despite being an old subject, is presently receiving a huge push from government to address the healthcare inadequacy in India. The speciality health infrastructure is a need of the hour and presents an opportunity for telecom vendors, healthcare providers and policy makers to provide healthcare to masses.
This document identifies the opportunity in telemedicine and indicates the efforts so far.
The Indonesia HiT reports the significant improvement in the health status of the population over the last 25 years through transitional period in all fields. However, the country faces remaining and foreseeing challenges in communicable diseases and emerging NCDs. The HiT concludes with the future challenges of expanding coverage of National health insurance scheme (JKN), reducing regional disparities in health-care services, managing resources and engaging private sector.
Health Financing for UHC – two sides of the coinHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Health access for all Thailand’s.The Thai citizens gain universal access to essential health services at zero cost, and reap significant benefits as babies get healthier, workers increase productivity, and households reduce financial risk.
Health workforce Statistics: Current Needs and Requirements
Introduction
Trained healthcare workforce is an important determinant of efficiency and outcomes of any health system as devised by WHO health systems approach. India one of the most populous country of the world has always felt a dire need of healthcare workforce even having one of the largest medical education and capacity building system. On the other hand we have a variety of health cadre namely from an ASHA to super specialized doctors. In our presentation we have critically analyzed the distribution of health workforce in India and its impacts on health and healthcare delivery for the mass of our society.
The Health Workforce in Nutshell
India faces an acute shortage of trained health workforce. India has a large basket of interventions to improve the healthcare but they are adversely effected by shortage of trained, motivated and supported health workforce. The shortages and misdistribution of health workforce have a large contribution to inequities in health outcomes. India’s health workforce is a combination of both registered, formal health-care providers and informal medical practitioners. We have a very unique health system with a large public health system and a blanket of juxtaposed private health care system. Similar situation is also present in training and education of health workforce. There is also a lack of data on the exact number of health care providers.
Issues
Quite a percentage of Indian population is spread in the rural areas but on the other hand the concentration of health care is in the urban system. The health care providers are highly concentrated in the urban area. Health worker densities are very low in rural settings when compared with urban areas. The next issue is lack of support to the health care providers practicing in the rural area and attraction of high income, support and provisions in the urban settings for the highly specialized workforce which includes doctors, dentist etc. At the national level, the aggregate density of doctors, nurses and midwives was 2.08 per 1000 population, which was lower than WHO’s critical shortage threshold of 2.28 .
Conclusion
In a concluding remark the production of health workforce has increased too many folds which has cost increased privatization of health education. On the other hand the public medical education system has not expanded at the required level. There is need to tap the potential in the private players with keep in mind stringent control of quality and cost. The increase in production is not going to resolve the issues of health worker availability and distribution. The need of the hour is to find sustainable measures to target the acute shortfall in the trained health workforce in India.
Australia has a mainly tax-funded health care system, with medical services subsidized through a universal national health insurance scheme.
some review about it.
The Australian healthcare system provides a wide range of services, from population health and prevention through to general practice and community health; emergency health services and hospital care; and rehabilitation and palliative care.
STRENGTHS & WEAKNESSES OFJAPANS' HEALTH CARE SYSTEMnaeemrsat
Japans' excellent health indicators are not entirely due to its' health delivery system. A major factor is the obsession of the Japanese for healthy life styles and food.
Also another big factor is Japans' excellent and very effective public health system
Telemedicine: An opportunity in Healthcare in IndiaAmit Bhargava
Telemedicine, despite being an old subject, is presently receiving a huge push from government to address the healthcare inadequacy in India. The speciality health infrastructure is a need of the hour and presents an opportunity for telecom vendors, healthcare providers and policy makers to provide healthcare to masses.
This document identifies the opportunity in telemedicine and indicates the efforts so far.
This review outlines the main organizational, financing, human resources and service delivery features of the health-care system. Although there has been implement in overall health outcomes since the 1990’s the current levels are still below average for the country’s Pacific neighbors. The remoteness of the many rural communities has hampered improvements in health services. This is one of the major challenges that the country faces in order to achieve SDG heath targets by 2030. This Hits highlights steps taken to overcome challenges especially in the face of epidemiological change in disease burden that is slowly taking place in the country.
Essential Package of Health Services Country Snapshot: BangladeshHFG Project
Resource Type: Brief
Authors: Jenna Wright
Published: July 2015
Resource Description:
An Essential Package of Health Services (EPHS) can be defined as the package of services that the government is providing or is aspiring to provide to its citizens in an equitable manner. Essential packages are often expected to achieve multiple goals: improved efficiency, equity, political empowerment, accountability, and altogether more effective care. There is no universal essential package of health services that applies to every country in the world.
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
The government of Bangladesh first defined an “Essential Service Package” in 1998, then updated it in 2003 and renamed it the “Essential Service Delivery” Package. This package is defined at a high level, and includes: child health care, safe motherhood, family planning, menstrual regulation, post-abortion care, and management of sexually transmitted infections; communicable diseases (including tuberculosis, malaria, others); emerging noncommunicable diseases (diabetes, mental health conditions, cardiovascular diseases); limited curative care and behavior change communication; and nutrition.
INDIA : TOWARDS UNIVERSAL HEALTH COVERAGEDevesh Shukla
Challenges of Universal Health provision
Urban – Rural Divide Statistics
Current state of Healthcare in India
Change in consumer mindset
Milestones in Independent India
Way Forward in Health care
HealthCare System in Thailand:Past -
Present and Where is the Future ?
Dr. Pradit Sintavanarong
Minister of Ministry of Public Health, Thailand
ริชมอนด์ 11-10-56
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
Health financing within the overall health systemHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Prof. Tanimola Akande and Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
This review outlines the main organizational, financing, human resources and service delivery features of the health-care system. Although there has been implement in overall health outcomes since the 1990’s the current levels are still below average for the country’s Pacific neighbors. The remoteness of the many rural communities has hampered improvements in health services. This is one of the major challenges that the country faces in order to achieve SDG heath targets by 2030. This Hits highlights steps taken to overcome challenges especially in the face of epidemiological change in disease burden that is slowly taking place in the country.
Essential Package of Health Services Country Snapshot: BangladeshHFG Project
Resource Type: Brief
Authors: Jenna Wright
Published: July 2015
Resource Description:
An Essential Package of Health Services (EPHS) can be defined as the package of services that the government is providing or is aspiring to provide to its citizens in an equitable manner. Essential packages are often expected to achieve multiple goals: improved efficiency, equity, political empowerment, accountability, and altogether more effective care. There is no universal essential package of health services that applies to every country in the world.
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
The government of Bangladesh first defined an “Essential Service Package” in 1998, then updated it in 2003 and renamed it the “Essential Service Delivery” Package. This package is defined at a high level, and includes: child health care, safe motherhood, family planning, menstrual regulation, post-abortion care, and management of sexually transmitted infections; communicable diseases (including tuberculosis, malaria, others); emerging noncommunicable diseases (diabetes, mental health conditions, cardiovascular diseases); limited curative care and behavior change communication; and nutrition.
INDIA : TOWARDS UNIVERSAL HEALTH COVERAGEDevesh Shukla
Challenges of Universal Health provision
Urban – Rural Divide Statistics
Current state of Healthcare in India
Change in consumer mindset
Milestones in Independent India
Way Forward in Health care
HealthCare System in Thailand:Past -
Present and Where is the Future ?
Dr. Pradit Sintavanarong
Minister of Ministry of Public Health, Thailand
ริชมอนด์ 11-10-56
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
Health financing within the overall health systemHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Prof. Tanimola Akande and Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
How do we see the healthcare's digital future and its impact on our lives?Jane Vita
"Healthcare is undergoing major changes spurred on by, but not limited to, technology.
Digitalisation is changing the way we think about health, what taking care of it really entails, our personal role in healthcare systems and the way we interact with technology in the context of health.
In many ways, we are entering a post-institutional age of increased personal responsibility, which presents healthcare service providers and other players in the field with major opportunities and great risks. Technology has the potential to empower people and help them become more active in the management of their and their families’ health. This will change the relationship of the patient and the caregiver in profound ways." Mirkka Länsisalo
A co-creation with Mirkka Läansisalo and Sala Heinänen, at Futurice.
An introductory overview of healthcare across South East Asia and a look at the growing healthcare trends across the region.
Download the presentation by clicking the "Save this presentation" icon above.
In Healthcare, we provide detailed analysis and projections of healthcare fields, occupations, and their wages. In addition, we discuss the important skills and work values associated with healthcare fields and occupations. Finally, We analyze the implications of our findings for the racial, ethnic, and class diversity of the healthcare workforce in the coming decade.
ASEAN shows a strong growth of health expenditure per capita leading by Singapore, Malaysia and Thailand. To find out more about other countries, check out our latest publication at http://bit.ly/1hmvwFq
This whitepaper provides an overview of medical device manufacturing in Asia. This paper includes key information on the global medical device market, global medical device market trends, Asia medical device market trends, Asia medical device manufacturing, setting up manufacturing facilities in Asia, and examples of manufacturing facilities in Asia. This whitepaper is intended for anyone interested in setting up or acquiring medical device manufacturing facilities in Asia.
For more information, contact us for a free 15 minute consultation at http://www.pacificbridgemedical.com/contact-us/.
Roadmap for Universal Health Care. FDR, PHFI, and Loksatta are convening a Roundtable of experts, thinkers and practitioners to have a purposive dialogue and help evolve a viable, effective model of universal healthcare delivery in India
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
There are numerous changes taking place in South Africa, in the economy, politics and health. All these are interdependent and embedded in a social milieu which brings a number of pressures on health services and systems. The major event in the medium to long term is the impact of the National Health Insurance. Other contextual factors of importance include the range of social determinants of health and disease, with the provision of water, sanitation, electricity and housing being the key services. South Africa will also be influenced in the future by the major diseases it harbours at present. This seminar provided some insight into how these factors will impact on the South African Health Services.
By Mr. Irish Pereira. With perspective on Healthcare Infrastructure, this report consists of an brief introduction of Indian healthcare sector, its market size, its growth drivers, healthcare infrastructure in India both public as well as private, Key Players in the Private Healthcare Segment,
Universal Health Coverage and Health Insurance - IndiaDr Chetan C P
Presentation is a case about cutting the risk fragmentation and having a universal pool for Health Insurance as one of the tools for achieving UHC in India.
Future of Thailand's Healthcare Industry in tier 2 cities
http://www.solidiance.com/whitepaper/future-of-thailands-healthcare-industry-in-tier-2-cities.pdf
http://www.marketresearchthailand.com/thailands-tier-2-cities-strive-in-medical-tourism/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Indonesia Healthcare Landscape - An Overview, July 2014
1. CAT PULT
This document has been produced by Catapult Pte Ltd. Copyright restrictions (including those of 3rd parties)
are to be observed. All information, views and advice are given in good faith. Whilst every effort has been
made to ensure the accuracy of the information and data contained herein, Catapult accepts no
responsibility for any errors and omissions, however caused. Information contained in this document is not
legal advice and does not bear any legal responsibility.!
Prepared by Catapult! July 2014!
Indonesia Healthcare Landscape!
An Overview!
4. Strictly Confidential
4
A Brief Overview
!
* PPP is Public Private Partnerships
Sources: ADB – Asian Development Outlook (‘14); World Bank – Economic Quarterly (Mar ‘14) & Development Policy Review (May ‘14)
Contributors to Indonesia’s Growth – Demand-side § Overall, current macro-economic
situation demands caution given the
following:
- Return to current account deficit since
2012 (currently nearly 3% of GDP)
- Recent policies such as new trade &
foreign ownership laws (and ban on
unprocessed mineral exports), which
negatively impact investment climate
§ Only adjustment in structural
factors will bring about sustainable,
long-term positive change
- Policies that encourage manufacturing
investment (& investment in
infrastructure, not just in construction)
- Allow increased private sector
investments (on capex), incl. through
mechanisms such as PPP projects
4.6
6.2
6.5
6.3
5.8
-3.0
-1.0
1.0
3.0
5.0
7.0
2009 2010 2011 2012 2013
Private consumption Government consumption
Fixed investment Change in inventories
Net exports Statistical discrepancy
% GDP
Note: Y-axis, in %
Rapid economic expansion between 2009-2012 raised expectations significantly for Indonesia;
growth expectations, at least for the next 2 years, have been tempered back
5. Strictly Confidential
5
Short-to-Medium Term Challenges
basis key current macro issues!
* As of revised budget estimates for 2013
Sources: World Bank – Indonesia Development Policy Review (May 2014 Report); Asian Wall Street Journal (news item 03rd July 2014)
Going forward, unfavorable economic policies is a key risk; Unless foreign investment in
capacity creation is encouraged, Indonesia health system will remain under-served
Potential Risks –
Health Sector
1. Fiscal pressure,
impacting Government
spending
Challenges
§ Slowing economy has resulted in
lower government revenues (95% of
budget*), reducing its ability to spend
– Despite this trend, deficit is set
to rise in 2014, putting further
strain on government spending
§ Inadequate spending under
universal healthcare, which
would demand (read: needs)
increased funds allocation
from the govt.
§ Fixed investment as % of GDP has
started to dip, after rising strongly
(25% to ~33%, between 2007-12)
§ FDI is at <3% of GDP, has plateaued
in 2013 (& slowing in 2014)
§ Fiscal challenges could mean
required & necessary govt.
investment in health
infrastructure takes a back
seat vis-à-vis other priorities
§ Over-reliance on investments in
mining and in construction
§ Investment in high-technology
manufacturing not materializing
(e.g. Samsung, Blackberry, Foxconn)
§ Investments, incl. in new
technology/services in health
sector has not picked up à
Indonesians continue to go
abroad for treatment
2. Investment slowdown
(incl. Foreign Direct
Investment)
3. Lack of high value-
add manufacturing &
services
Why?
7. Strictly Confidential
7
Healthcare Landscape, 1 of 2!
an overview
!
Central /
Other
Agencies*
District /
Provincial /
Municipal
Sub-District, Commune
and Village
Set Up
~ 200 hospitals (est. 26,500
beds all together)
~380 hospital (est. 48,500
beds)
~ 30,000 facilities (of which
only about 2,500 of these
provide in-patient facilities)
Notes
§ Only approx. 3/4th of the public
health budget is spent year-after-
year
§ Absenteeism remains high &
rampant (up to ~40% for doctors
remain absent from duties)
§ Continued dependence on
pharmacies/drug-stores for diagnosis
& prescription – self treatment (for
those ill) remains high (~50% in ’06)
Briefly,
§ Over & above the public facilities – as highlighted above – there are nearly 450 hospitals in the private sector
(accounting for ~ 37%, or 44,000 beds across the country), though they are largely concentrated in the top 5 cities
of Jakarta, Surabaya, Bali (Denpasar), Medan & Yogyakarta
§ Various estimates suggest Indonesians spend nearly US $ 1 Bn. in health services in neighboring Singapore &
Malaysia (medical tourism for the two countries)
§ There is unequal distribution of health personnel across the country, with an estimated 18 of the 33 provinces
having less than 1 doctor per puskesmas (sub-district level primary care facility)
Overall, an est. 1,050 hospitals in the country
* Other Agencies include Armed Forces, or Police, or other ministry-owned or State-owned Enterprise
Sources: World Bank, USAID Report (2009); Catapult analysis
8. Strictly Confidential
Overall, there were only approx. 70,000 medical doctors in the country, with only about 15,000 specialists
Healthcare Landscape, 2 of 2!
an overview
!
8
Sources: Ministry of Health; Health Financing in Indonesia, World Bank (2009); Indonesian Medical Council, http://www.inamc.or.id/
Java &
Bali
% of
Population
% of
Hospitals
% No. of
Beds
% of all
Doctors
59% 51% 55% 67%
Sumatra 22% 25% 23% 19%
Rest of
Country
19% 24% 22% 14%
9. Strictly Confidential
The employed
(~131 Mn.)
Health Insurance Coverage
an overview
!
Current
Population
(~240 Mn.)
Police and
Military
Military Health
Services 2.2 Mn.
Civil Servants
ASKES (Civil
Servants
insurance)
17.3 Mn.
Private Sector
JAMSOSTEK
(Workers Social
Security)
5.6 Mn.
Private (self-
insured) &
Commercial
Insurance
18.3 Mn.
No Insurance /
Reimbursement
System
88.4 Mn.
Self
Employed /
Unemployed
(~108 Mn.)
JAMKESMAS
(health insurance
for the poor)
76.4 Mn.*
JAMKESDA
(regional govt.
health insurance)
31.9 Mn.
~25 Mn.
insured
under
different
govt.
schemes
~18.3 Mn.
insured in
the private
sector
~108.3 Mn.
insured by
under 2
schemes
2012
Targeted to go to
257.5 Mn. (the
entire population)
by 2019
* Expected to increase to 86.4 Mn. people by end-2013 as part of transition to universal coverage
Notes: Figures may not fully add-up due to rounding-off error; data as of 2012
9
10. Strictly Confidential
10
Roadmap to Universal Health Coverage
present-day to 2019!
Universal Health Coverage under BPJS I
As of Jan 2014 2015 2016 2017 2018 2019
~122 Mn. under
mgmt. of BPJS I
257.5 Mn. people
covered by UHC
Private sector
coverage (according
to company size):
- 20% large
- 20% medium
- 10% small
- 10% micro
companies
Private sector
coverage(according
to company size):
- 50% large
- 50% medium
- 30% small
- 25% micro
Companies
All JAMKESDA
members will be
covered by BPJS
Private sector target
coverage (according
to company size):
- 75% of large
- 75% medium
- 50% small
- 40% micro
companies
Private sector
coverage (according
to company size):
- 100% large
- 100% medium
- 70% small
- 60% micro
companies
Private sector
coverage
(according to
company size):
- 100% large
- 100% medium
- 100% small
- 80% micro
companies
Target 100% of
Indonesia population
~15 Mn. people still
covered by
JAMKESDA
Jamkesmas, operational since 2005, is estimated to have ~122 Mn. members (as of Jan 2014),
when UHC started under BPJS I
12. Strictly Confidential
12
Drivers and Key Challenges
likely developments in health landscape!
Macro-Economic
factors
Health Financing
& Sector reforms
Disease Burden
& Treatment
Challenges
Infrastructure /
Capacity creation
§ Despite challenges,
economy is likely to be
among the fastest
growing within ASEAN
(5.5%+ y-o-y), in the
medium-term
§ Indonesia is rapidly
urbanizing & would
have ~135-140 Mn.
middle-income &
affluent consumers by
2020
§ Expenditure on health is
amongst the lowest in
the region (<3 % of GDP,
of which govt. spending is
~1.2%)
§ Implementation of the
Universal Health
Coverage scheme is the
biggest health reform
undertaken. Over time,
this has the potential to
transform health services
in the country, though
funding challenges remain
§ ~2/3rd of all deaths are
caused by non-
communicable
diseases (also, >50%
of deaths are due to
chronic conditions)
§ TB & other respiratory
diseases are significant
challenges, as are CVD
and certain cancers
§ There is also
significant variation in
treatment rates in
rural areas, given
generally poor facilities
§ Indonesia’s existing
health infrastructure is
old & dilapidated. It
suffers from the problem
of poor manpower
resources, lack of
investments in
equipments & other
systemic issues
(absenteeism, corruption)
§ Unless new, capacity is
created (in both, primary
& secondary care),
chronic issues to persist
Sources: Ministry of Health; World Bank Reports (multiple); Asia’s Next Big Opportunity – BCG (2013 Report); Unleashing Indonesia’s
Potential – McKinsey (2012 Report); Catapult analysis
14. Strictly Confidential
Evolution of Indonesia’s Health Insurance Programs
up to 2012
!
Year Initiative
1968 Health Insurance for civil servants
1992 Social Security for Private Sector employees – Jamsostek, JPKM (HMOs) and CBHI
1999 JPS (Social Safety Net); financial assistance for the poor via ADB loan
2000
Comprehensive review of health insurance and amendment of constitution to prescribe the
rights to health care
2004
National Social Security (SJSN) Law (No. 40/2004) mandated social health insurance for the
entire population
2004 Introduction of Asuransi Kesehatan Masyarakat Miskin (health insurance for the poor)
2008 Askeskin is renamed Jamkesmas and extended to the near poor
2010
Law No. 17: The National Development Middle Plan (RPJMN) reconfirmed Indonesia’s
commitment to provide universal health coverage by 2014
2011
Constitution No. 24/2011: Social Security Providers Bill is passed, which mandates that
the Social Security Agency (BPJS) would be operational by January 1, 2014
Sources: http://www.uhcforward.org/content/indonesia; jamsosindonesia.com/english
14
15. Strictly Confidential
15
Key Elements of Universal Health Coverage
funding and resource contributions
!
* Original calculations were for a subsidy of between Rp 22,000 – Rp 27,000 per person per month for those categorized as poor; premium
contributions also differ by type of hospital accessed for services
** 3% paid by employer & 2% by employee (in certain cases share of contribution is 4% employer & 1% employee); though under Jamsostek it is
mandatory to register employees, compliance (estimates suggest only about 25% of formal sector employees are currently covered)
Note: DRG is Diagnosis Related Group; INA-CBG is Indonesia Definitions; exchange rate may not up to date; $ are US$
Resource Contributions Extent of Pooling Purchasing / Provision
Govt.
Rp 15,500 (~ $ 1.5)
payout* (revised
subsidy in 2013) /
person / mth. by the
govt. as contribution
for the poor
Existing funds to be pooled by 2014:
§ Jamkesmas
§ TNI/Polri (military & police)
§ Askes PNS (civil servants)
§ JPK Jamsostek
§ Some of Jamkesda
TOTAL: 121.6 million
Hospital
§ DRG payments based on
INA-CBG. Amounts to be
negotiated with hospital
associations & to vary
according to region
Formal
Sector
5% of wages**
shared between
employer &
employee
By 2019: total population, incl.
remainder of Jamkesda schemes
TOTAL: 257.5 million
Primary
Health
Centre
§ Monthly capitation
contribution based on
registered users for public
& private clinics
Informal
Sector
Self-funded
contribution of ~5-6%
of monthly income
(+some govt.
contribution)
BPJS as single institution managing
pooled funds to be formed by
conversion of PT Askes
Benefit
Package
§ Comprehensive
§ Initially public ward for
govt. contributor & 2nd
class ward for self-
funded; shift to 2nd class
for all by 2019