Opening Plenary: Key Issues in Indonesian Health System.

Summary

The Honorable Minister for Health, Pakabi Gunady Sadikin, outlines Indonesia's healthcare reform efforts, focusing on expanding universal health coverage and improving primary and secondary care systems. Key initiatives include the implementation of nationwide health screenings, revitalizing primary care services, and addressing critical gaps in medical infrastructure. With substantial support from international banks, Indonesia is enhancing its medical facilities and workforce, while also prioritizing preventative care to reduce long-term healthcare costs. The Minister emphasizes the importance of balancing insurance schemes to ensure sustainability and equitable access to healthcare for all Indonesians.

Takeaways

• 😀 Indonesia’s National Insurance Scheme covers 280 million people, but real access to healthcare remains limited due to insufficient hospitals, medical devices, and doctors.
• 😀 The government launched six pillars of healthcare reform, focusing on primary care, secondary care, and health financing.
• 😀 Primary care reform expands coverage from 10,000 district offices to 85,000 villages and emphasizes digitalization, preventive programs, and public health laboratory networks.
• 😀 A mandatory population screening program was initiated in February 2025, targeting all age groups and providing AI-driven health advice with follow-up care and free medications.
• 😀 Secondary care reform addresses critical conditions such as stroke and heart attack, increasing facility coverage from 44 to 112 cities, aiming for full coverage in 514 cities by 2027.
• 😀 Advanced medical devices such as CT scans, cath labs, PET scans, and LINACs are being distributed across provinces to improve diagnostic and treatment capabilities.
• 😀 Indonesia faces a severe shortage of specialized doctors; fellowship programs in India, China, Japan, and Korea aim to rapidly train and return specialists to Indonesia.
• 😀 Healthcare spending is $40 billion/year (~$140 per person), with costs projected to triple in the next 5–10 years if preventive measures are not strengthened.
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• 😀 National insurance coverage is currently 27% and private insurance 5%; expanding insurance coverage to 80–90% is a key strategy to reduce out-of-pocket expenses and control costs.
• 😀 Focus on promotive and preventive care is essential for long-term cost sustainability and to avoid the high costs associated with purely curative healthcare systems.
• 😀 Integration of national and private insurance benefits, redesign of disease risk group diagnostics, and inclusion of palliative and restorative care are part of the long-term strategy.

Q & A

What was the main reason Pakabi Gunady Sadikin couldn't join the event in person?

Pakabi Gunady Sadikin couldn't join the event in person because he was unable to attend physically, but he was able to join online from his office in Jakarta.

What is Indonesia's universal health coverage, and what challenge did the minister discover about it?

Indonesia's universal health coverage is based on a national insurance scheme covering 280 million members. However, the minister discovered that while the coverage provides access, it doesn’t ensure actual access to healthcare services, as there aren't enough hospitals, medical devices, or doctors to meet the demand.

What are the six pillars of Indonesia's healthcare reform?

The six pillars of Indonesia's healthcare reform include: 1) Primary care reform, 2) Secondary care transformation, 3) Health financing, 4) Expanding medical device access, 5) Expanding the healthcare workforce, and 6) Strengthening the healthcare system through digital and technological innovations.

What is the major initiative that Pakabi Gunady Sadikin introduced for primary care?

A major initiative in primary care is the massive annual screening program, where 280 million Indonesians are screened for various health conditions. The program uses digital tools like WhatsApp messages to send health summaries and provide free treatments for common health issues.

How does the screening program work, and what are its goals?

The screening program checks health conditions like blood pressure, blood sugar, and kidney health. Results are sent via WhatsApp, allowing individuals to access follow-up care at primary healthcare clinics. The program aims to screen 250 million people annually by year five.

How is Indonesia addressing the shortage of healthcare facilities, particularly for serious conditions like stroke and heart attack?

Indonesia is addressing the shortage of healthcare facilities by procuring and distributing medical devices like CT scans, cat labs, and bypass surgery equipment across 514 cities. This effort aims to ensure that local cities can handle serious health conditions like strokes and heart attacks, rather than requiring patients to be flown to other cities.

What progress has been made in expanding healthcare services to handle heart attacks and strokes?

The number of cities capable of handling stroke and heart attack cases has increased from 44 to 112 out of 514 cities. The goal is to equip all 514 cities with the necessary facilities by the end of 2027.

What are some challenges faced by Indonesia in terms of healthcare professionals, especially for specialized care?

Indonesia faces a significant shortage of specialized healthcare professionals, with gaps in critical areas like cardiologists, neurologists, oncologists, and others. For example, there are only 88 medical oncologists in Indonesia, but the country needs 482.

What steps are being taken to address the shortage of healthcare professionals in Indonesia?

Indonesia is increasing its healthcare workforce by sending doctors abroad for training in countries like India, China, Japan, and Korea. The aim is to accelerate the development of specialized doctors who can return to Indonesia and help bridge the healthcare gap.

Why is health financing a critical issue for Indonesia, and what concerns does the minister have?

Health financing is a critical issue because the country's healthcare spending is increasing rapidly, and there are concerns that this will become unsustainable. The minister is especially concerned about the rising healthcare costs, which may exceed the country's GDP growth, leading to a financial burden on Indonesia in the future.