Sistem Pembiayaan Kesehatan Masyarakat

Summary

This transcript discusses the challenges and solutions surrounding health financing in Indonesia, focusing on the implementation of the National Social Security System (SJSN) and the role of BPJS Kesehatan. It highlights the importance of a sustainable health financing model through social insurance, where contributions are made by individuals, employers, and the government. BPJS Kesehatan is tasked with managing these contributions, ensuring risk pooling, and optimizing health service delivery. The video stresses the need for organizational adjustments and efficient management to guarantee accessibility, affordability, and long-term viability of health services for all Indonesian citizens.

Takeaways

• 😀 The rising healthcare service costs are making it harder for people to access healthcare, especially when they have to pay out of pocket.
• 😀 The government aims to address this by developing an effective and efficient healthcare financing system through the National Social Security System (SJSN) under Law No. 40 of 2004.
• 😀 The Indonesian government has implemented a social insurance-based health program that applies to all citizens, using contributions from the government, employers, and individuals.
• 😀 Contributions are collected and managed by institutions, either public or private, and can be used for healthcare services when participants need them.
• 😀 The health insurance system aims to ensure accessibility to affordable healthcare and spread financial risks across all participants through cross-subsidization, from high-risk to low-risk individuals.
• 😀 The core functions of the health financing system include income collection, risk pooling, and benefit purchasing through a payment mechanism to healthcare facilities.
• 😀 BPJS Kesehatan, as the implementing body, must adjust its organizational structure and policies to effectively manage these three functions.
• 😀 The changes in BPJS Kesehatan require a shift in thinking and working methods, as previous approaches are no longer relevant to the evolving healthcare system.
• 😀 BPJS Kesehatan plays a critical role in balancing incoming funds with operational costs and ensuring the sustainability of the health insurance program.
• 😀 The success of the health insurance program depends on managing operational costs efficiently, as well as the ability to recruit healthy and capable participants who can pay contributions.
• 😀 The implementation of health insurance programs globally shows that healthcare service costs rise faster than inflation, so primary healthcare services must be well-managed to minimize costs before referrals to higher-level services.

Q & A

What are the primary challenges faced by healthcare systems in many countries, as discussed in the transcript?

The primary challenges are the rising costs of healthcare services, which make it difficult for populations to access care, especially when the costs have to be borne out-of-pocket.

How does the Indonesian government aim to address these challenges in healthcare access?

The Indonesian government aims to address these challenges through the development of an effective and efficient health financing system, primarily through the Social Health Insurance (SJSN) program established by Law No. 40 of 2004.

What is the key principle behind Indonesia's health financing system, and how does it work?

The key principle is social insurance, which involves contributions from various stakeholders, including the government, employers, and workers. These contributions are pooled together to fund healthcare services for participants.

What does 'rich pooling' mean in the context of Indonesia's health financing system?

'Rich pooling' refers to the distribution of financial risks across all participants, with wealthier individuals and those with lower health risks subsidizing those who are at higher risk or in lower economic brackets.

What are the three essential functions for the success of Indonesia's health financing system?

The three essential functions are: 1) Revenue collection through contributions, 2) Risk pooling through cross-subsidies, and 3) Benefit purchasing through payment systems to healthcare providers.

What role does BPJS Kesehatan play in the implementation of the health financing system?

BPJS Kesehatan is responsible for managing the health financing system by collecting contributions, ensuring the distribution of risks, and overseeing the payment mechanisms to healthcare providers.

What organizational changes are necessary for BPJS Kesehatan to effectively manage the health financing system?

BPJS Kesehatan needs to restructure its organization, adjust policies, and develop strategies that include a clear vision, mission, and values. It also requires a shift in mindset and approach to adapt to new operational and strategic realities.

What is the impact of 'selection bias' on the sustainability of the health insurance program?

Selection bias occurs when primarily unhealthy individuals join the program, which can undermine the program's sustainability. To prevent this, the focus should be on attracting healthy and financially capable participants.

What factors are crucial for the success of BPJS Kesehatan and the national health insurance program?

The success of BPJS Kesehatan depends on three factors: ensuring adequate and appropriate funding, managing funds efficiently for both healthcare services and operational costs, and providing financial accessibility to healthcare for all citizens.

Why is it important for BPJS Kesehatan to manage healthcare costs effectively, especially at the primary healthcare level?

Managing healthcare costs at the primary level is crucial because it helps minimize the risk of higher costs later, such as through referrals to specialist care. This approach prioritizes preventive and promotive services, which can reduce overall healthcare expenses.