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Indonesia: Universal Health Care Program Implemented

(Jan. 6, 2014) Indonesia's government has said it is implementing a universal health care program, beginning on January 1, 2014. (Nadya Natahadibrata, Indonesia’s government has said it is implementing a universal health care program, beginning on January 1, 2014. (Nadya Natahadibrata, Govt Set to Launch “Milestone” Program, THE JAKARTA POST (Dec. 31, 2013).) The program has taken about a decade to develop, following the adoption of the underlying legal basis for it, the 2004 Law on the National Social Security System; chapter II, section 6, covers health insurance. (Law of the Republic of Indonesia No. 40 of 2004 Concerning the National Social Security System, NATLEX (unofficial translation); Undang-Undang Nomor 40 Tahun 2004 Tentang Sistem Jaminan Sosial Nasional, House of Representatives website.) In addition to health insurance, Indonesia’s social security system covers several programs, including pensions for the retired and benefits available to those suffering occupational injuries. (Hasbullah Thabrany, Birth of Indonesia’s “Medicare”: Fasten Your Seatbelts, THE JAKARTA POST (Jan. 2, 2014).)

In a December 30, 2013, statement, Indonesia’s President, Susilo Bambang Yudhoyono, described the new program as “a milestone in the country’s history” and added that “it will change the welfare of Indonesians. This will create more equitable development, especially for those who are less fortunate.” (Natahadibrata, supra.) The new health program will eventually cover all citizens and foreigners residing in the country for more than six months. (Thabrany, supra.) It will be implemented through the Social Security Providers (BPJS) Law (Law No. 24, 2011 [in Indonesian], House of Representatives website), together with twelve regulations and five presidential decrees. (Natahadibrata, supra.)

Features of the Program

The government will fully cover health costs for those unable to pay for a minimal level of care. Those so covered will be able to obtain medical attention anywhere in the country. Among Indonesians, it is estimated that more than 86 million, out of a total population of about 251 million, will be eligible for assistance with the insurance premium payments. (Id.; U.S. Census Bureau, Midyear Population and Density – Custom Region – Indonesia, INTERNATIONAL DATABASE (2013).) Those able to pay for insurance will have fees on a sliding scale, based on whether they are fully employed and the level of coverage they choose. For those working in the private sector, the fee will be 5% of monthly income; as of 2015, employers will have to cover 4% and employees will pay the last 1%. Natahadibrata, supra.) The state-owned insurance company Askes has been designated as the agency to run the program. It will become BPJS Kesehatan (Social Security Provider – Health), integrating four existing programs into one unified system. (Thabrany, supra.) The goal is to include 140 million people in the program by the end of January 2014, with the entire country to be covered by 2019. According to Fahmi Idris of Askes, the online system for registering individuals is in place and more than 111 million were already signed up by December 10, 2013. (Natahadibrata, supra.)

Criticisms of the Plan

Some critics have questioned whether the program is fully ready for implementation. The opposition Indonesian Democratic Party of Struggle suggested that the government’s plan to conduct a new survey to determine how many Indonesians qualify for assistance with health insurance demonstrates a lack of readiness. The Party has also pointed out that different government departments have different estimates of the number of poor people in the country, ranging from 40 million to 70 million. (Id.)

Zainal Abidin of the Indonesian Doctors Association also argued that there has been insufficient preparation, with a lack of information for health workers and the public. He stated on December 30 that “[m]ost health workers still don’t know how the program will work, what types of services we should provide and if the premium is enough to pay for a particular service. … We can only run the program while learning about it and evaluating it.” (Id.) Furthermore, an editorial by the Chair of the Center for Health Economics and Policy Studies at the University of Indonesia stated that the amount the government will contribute to subsidize insurance costs for low-income Indonesians is inadequate. (Thabrany, supra.)

Additional concerns have been raised about the general quality and availability of health care in Indonesia, with questions on a number of issues, including the number of specialists practicing in the country. (Id.) Minister of Health Nafsiah Mboi has said a major concern “is the quality of our healthcare services. … So far, we have been preparing rigorously to improve the quality of care. For healthcare facilities, our vision is a very strong primary care network combined with a good quality referral system.” (Will Indonesia Achieve Universal Healthcare Coverage?, PHARMA BOARDROOM (Sept. 25, 2013).)