Authors: Darmawan Prasetya and Eka Afrina, The Prakarsa Centre for Welfare Research 

In July 2022, the Indonesian authorities launched the Customary Inpatient Class (KRIS) system in a number of hospitals nationwide. The system includes rules associated to room services, which may enhance the requirements, safety and luxury of healthcare providers.

The present three-tiered class-based system — underneath which healthcare therapy is break up into three courses with various month-to-month premiums that decide the ward a affected person receives — will probably be nullified. Month-to-month contributions for sophistication one and two members of the Jaminan Kesehatan Nasional (JKN), Indonesia’s nationwide medical health insurance scheme, will even be decreased.

With the purpose of reaching common healthcare protection, the introduction of the usual system appears promising. However this modification solely scratches the floor of the difficulty, because the KRIS primarily focusses on well being facilities. To realize well being fairness, the federal government should handle a much bigger concern — the excessive out-of-pocket (OOP) expenditure on healthcare. Indonesia’s OOP expenditure is much above worldwide requirements and different nations within the area.

Indonesia’s OOP expenditure made up 34.76 per cent of complete well being expenditure in 2019. This proportion is larger than the World Well being Organisation’s (WHO) really helpful most of 20 per cent. Indonesia’s complete healthcare spending per capita can be low — forward solely of nations with far decrease per capita nationwide incomes like Cambodia, Myanmar and Laos. The common OOP healthcare expenditure of low- and middle-income nations in 2019 was 35.25 per cent. Indonesia’s OOP was solely barely above this determine and nonetheless removed from the 13.26 per cent common in superior economies.

The prices of prescribed drugs and healthcare providers are the primary contributors to excessive OOP in Indonesia. For instance, despite the fact that the JKN covers the prices of remedy for folks with mental disabilities, there are nonetheless challenges in accessing the best remedy.

The JKN not often covers the price of the total dosage. In some circumstances, the JKN solely covers the price of per week or a fortnight’s value of remedy. The JKN normally covers the price of cheaper medicines which have extra uncomfortable side effects, whereas dearer medicines, with delicate uncomfortable side effects, should not lined or solely partially lined.

Lengthy ready instances for therapy are nonetheless a hurdle to receiving correct healthcare. Sufferers who want surgical procedure face a mean wait time of between a fortnight and a month, if no more. This implies many JKN members select to get therapy outdoors the JKN system — forcing them to pay OOP and probably eroding their revenue and financial savings.

The principle reason for excessive OOP expenditure for medicines and healthcare providers is the low Indonesia Case Base Teams (INACBG) charges. Underneath the JKN system, hospitals obtain funds primarily based on the typical quantity spent (the INACBG charge) on a analysis or medical process.

A number of research have discovered that the prices of medical procedures are normally larger than capitation (the mounted cost to docs primarily based on the variety of sufferers) and INACBG tariffs. The issue is that INACBG tariffs haven’t modified since 2016. This restricted useful resource signifies that healthcare suppliers have restricted medical assets and provides and healthcare professionals obtain low salaries.

In response, the Indonesian authorities is at the moment debating an enhance in INACBG charges to beat extended underfunding points. However rising INACBG charges will even increase capitation charges and finally exacerbate the present deficit of the Social Well being Insurance coverage Administration Physique.

To make sure that INACBG charges are elevated with out elevating OOP prices for sufferers, the federal government should increase its well being expenditure. Indonesia’s healthcare spending is low in comparison with nations like China and Thailand. China and Thailand spend between 3.5 and 5 per cent of annual GDP on healthcare, whereas Indonesia’s well being expenditure stood at solely 2.9 per cent of its GDP in 2019. This determine will not be projected to achieve the WHO’s really helpful 5 per cent till 2027.

Implementing the KRIS system looks as if a promising approach to obtain equitable entry to healthcare because it erases the segmented therapy of sufferers utilizing the social insurance coverage system. However the system solely standardises room services and facilities for inpatient remedies, not outpatient remedies. Indonesia nonetheless wants to deal with excessive OOP expenditure and healthcare underfunding. Healthcare spending ought to be handled as a long-term funding in human assets.

The Indonesian authorities should be sure that all folks have equal entry to healthcare providers no matter their socioeconomic standing. Sufferers should obtain obligatory healthcare interventions primarily based on their healthcare wants, not their means to pay. It will scale back well being inequity and be a major step in the direction of common well being protection in Indonesia.

Darmawan Prasetya is Social Coverage Officer on the Prakarsa Centre for Welfare Research, Jakarta.

Eka Afrina is Analysis and Information Supervisor on the Prakarsa Centre for Welfare Research, Jakarta.