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Presentation

Session: Complementary Insurance
Room: Meeting Rooms 25+26
Time: Thu 14:30-15:45

Presenter: David Dunlop

Abstract

Achieving universal coverage of health insurance has been the goal of the long term health development plan in Indonesia. Under a decentralized system, the achievement of the goal is characterized by dominant role of around 496 autonomous districts. Currently around 60 districts operate local health insurance scheme, despite the debate whether the scheme should be managed by a single or a few number carrier or – as it is now – by multiple local schemes.

In order to assess the effectiveness of the local schemes, 15 district health insurance schemes which were operational for more than one year were reviewed from 36 total schemes operational in Indonesia in 2008. The first objective of the review was to define good practices among the schemes, and explore lessons learned from those schemes with good practices for use in guiding other sub-national units in the design and implementation of such schemes in other districts, and improving national policy guidance toward universal coverage of financial protection for health. The second objective was to review weaknesses of current schemes and propose interventions to remedy these identified concerns.

8 criteria were used to identify good practice, including: (a) the comprehensiveness of the benefit package, (b) the population coverage of the scheme, (c) the scheme’s legal status, (d) the process and methods employed to establish premiums, (e) whether and extent of member contribution to premium payment, (f) the claim verification process, (g) membership management procedures, and (h) the extent to which professionals were involved in managing the schemes. Each criteria was given a score ranging from 1 to 5. In addition, each criterion was weighted, based on the study team’s judgment on its contribution to 6 elements of an ideal scheme. These elements are: (a) degree of financial protection of members in the scheme, (b) sustainability of the scheme, (c) fairness of financial contribution across scheme members, (d) service quality, (e) good management practices as measured by the use of IT in membership and claim management (f) relevance to the national policy of social health insurance (SHI) development and (g) institutional stability. If a certain criteria were considered as contributing to the element, a score of 1 is given, otherwise it received a 0, if there is no contribution.

Through this process three local schemes have been identified. The highest ranked scheme has a score of 176 (76% of the total possible score). The high rank is attributed to its highest score for benefit package (comprehensive), coverage (entire population), claim verification and professional personnel. The second ranked scheme has a score of 142 or 67.6% of the highest possible score. The high score is attributed to good coverage, legal support, calculated premium, source of fund and professional personnel. The third
scheme has a score of 134 or 63.8% of the highest possible score and ranked on the third place among the 15 schemes evaluated. The relatively high score is attributed to the comprehensiveness of its benefit package, calculated premium setting, verification mechanism and availability of professional personnel.

With respect to the second objective the assessment revealed five main issues as the area of weakness among the schemes. The five issues are (1) coverage expansion, (2) premium setting, (3) financial contribution of the enrollees, (4) availability of health insurance professional and (5) legal status of the schemes institutions.
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The findings of this study suggest that the future work with the sub-national schemes should include dissemination of good practices and systematic work addressing the five main gaps in the existing schemes.

Key Terms

Local health insurance scheme

Authors:

Ascobat Gani (School of PH. Univ. of Indonesia) , Pujianto MKes (School of PH. Univ. of Indonesia) , Ferry Yanuar (Shool of PH. Univ. of Indonesia) , Thomas Weichers (ILO) and Dunlop David (AusAID Indonesia)

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