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Indonesia’s journey towards Universal Health Coverage: lessons from health insurance perspective

by Waranya Rattanavipapong and Benjarin Santatiwongchai

Indonesia implements a national health insurance system known as Jaminan Kesehatan Nasional (JKN) in 2014. Aside from commitment from government, several reforms, including expansion of provider network, provider payment schemes restructure and a system for the assessment of new health technologies, were instituted in order to achieve UHC. However, the challenges in the progress of UHC as perceived by health insurance are recognized.

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The Indonesian Health Economics Association (InaHEA), an association of experts in health economics in Indonesia, also recognizes the importance of this issue. In collaboration with Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga and Center for Health Economics and Policy Studies (CHEPS), Faculty of Public Health, Universitas Indonesia, InaHEA host the 4th Annual Scientific Meeting of InaHEA in theme of “The 3rd Year Implementation of National Health Insurance in Indonesia’ in Surabaya, Indonesia from 13-15 September 2017. In the attempt to learn from international experience and create a forum for experience sharing and capacity building, the organizing committee invited experts from various backgrounds and countries to share their experience on UHC. The International Decision Support Initiative (iDSI) by Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand and the Global Health and Development Group (GHD), Imperial College London were a part of the invited key speakers in the conference.

The pre-conference workshop was held on 13 September. Anthony J. Culyer (Chair of iDSI), Francis Ruiz (GHD), and Benjarin Santatiwongchai (HITAP) convened a workshop on Health Technology Assessment (HTA) and economic evaluation for health care program. The workshop aims to give a basic concept of HTA and economic evaluation and its benefits in supporting priority setting and effective resource allocation.

The main conference was participated by more than 300 participants. On the first day of the main conference, plenary sessions on Global Experience on HTA were organized. Waranya Rattanavipapong from HITAP shared the experiences in using HTA in Thailand for informing coverage decisions for health benefit package as Thailand is one of the countries where has seen as UHC success story.

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On the second day, there were various local health economic studies presented orally, as well as a large number of poster presentations. These includes more than 20 HTA studies, e.g. cost of illness and economic evaluation. Some are economic cost of tobacco while some focus on the cost of hypertension. There is a poster submitted on the cost-effectiveness of refractive error screening in primary school children by school teachers. These studies were conducted and presented by not only senior scholar, graduate students but also undergraduate students. This means capacity to do HTA which can inform the development of JKN in the future is being developed.

The journey towards the JKN is still long and requires concerted effort of all sectors. With all academic works done, Indonesia has far past the first step. They can be one of the building blocks to the sustainable universal health coverage for Indonesian population.

By Waranya Rattanavipapong and Benjarin Santatiwongchai, HITAP International Unit

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