PRIVATE SECTOR HEALTH CARE IN INDONESIA - Health Systems ...

How can financial incentives be used to improve access to services or qualityof services among private providers?2.12 Experience Contracting through Dinkes or Insurance SchemesThe quality of service among private providers remains unregulated. Askes credentialing of privateproviders in West Java rests on determining whether they are licensed, their geographic proximity to theclient base, and a visual inspection of the service site. This inspection is not codified against anestablished checklist of quality standards.IMA and IBI Province stated that they accept and service Jamkesmas and Gakin patients as mandated bylaw and as mentioned in their professional by laws. Also, they felt it was their social obligation to servethe underprivileged.2.13 Implementation of AskesAskes is a government insurance program covering civil servants and their families (up to two children).Funding comes from a mandatory contribution of 2 percent of the monthly basic salary matched by thegovernment as an employer. The total number of members nationwide was 14,576,900 insured. Thebenefit package is not basic care, but full, comprehensive health care including open heart surgery,hemodialysis, and cancer treatment. Members must register with a Puskesmas and cannot receive anysecondary care without a referral letter from the Puskesmas. Many civil servants, particularly the uppertier, do not make full use of the benefit because few civil servants would want to go to the Puskesmas.PT Askes (Persero) Cabang Utama Bandung covers four Districts including Bandung District. It covers540,000 lives that are served by public and private health care providers. They have 13,000 differentdrugs on their formulary that are covered by Askes.Out of a population of 40M in West Java, 178,786 are covered by Askes – Commercial. The capitationoffered by Askes – Commercial for outpatient coverage is Rp 2,500 per capita with no inclusion ofmedicines. Through member mapping, the average number of lives per contracted physician is 150. Thephysician may opt to be capitated at the rate of Rp 7,500 per capita which includes medicines. Askes hascontracts with the following providers: 16 clinical specialists, 280 GPs, 60 clinic facilities, 87 pharmacies,and 69 dentists.Askes – Commercial focuses primarily on company accounts. It currently serves 152 companies. One ofits major accounts is a railway company with 111,500 members. Based on information taken from PT AskesCentral Office, all Commercial businesses will be handled by PT InHealth.Under the Askes Sosial Plan currently administered by PT Askes (Persero) Cabang Utama Bandung,Askes affiliated with 24 hospitals, 5 of which are private hospitals, and 22 GPs. The criteria is based onmapping of where their members reside. The target is to have 60 GPs. GPs are capitated at Rp 2,500 percapita not inclusive of medicines and Rp 1,000 to Puskesmas. Another capitated fee option is Rp 7,500which includes medicine.Askes allows providers to charge in excess of the standard reimbursable amount; however, it negotiateswith the provider acceptable rate. Currently, Askes does not use IMA’s manual on clinical practiceguidelines which could be the basis for sound and acceptable quality medical practice in the actualprocess of claims adjudication.83