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

the midwife to charge a slightly higher fee than a normal delivery and also could be used to monitor thequality of services and referral patterns for this important condition. This could be done with only smallchanges to the current system, and yet a minor reform could lead to a significant improvement in care.In discussions with providers of maternal health care, there were a wide variety of small changes thatcould be made in the insurance payment method that could lead to significant improvements:• Increase payment to Bidan Delima members to create incentive for others to become membersat the same time ensuring quality of services to patients.• Reimbursement of gasoline consumption by District health office to midwives who transportobstetric emergencies to the hospital.• Profit sharing between hospital (and obstetrician/gynecologist) and referring midwife toincentivize midwives to refer early and when needed.• Reimbursement of expenses incurred at midwife facility before transfer of obstetric case tohospital (e.g. pay for obstetric emergency).• Create separate payment for antenatal care including higher payment for managing high-riskpatients such as eclampsia.• Move towards a mixed capitation/fee for service system for midwives to ensure adequateincome in any one geographical location to ensure income/payment.• District health office to offer capitation to midwives to ensure pre-payment of services.• Inclusion of contraceptives in Jamkesmas and Gakin schemes.In addition to these changes in insurance payment methods, there are some other complementaryinterventions in maternal health services that could also make a difference. For example, IBI could serveas “distributors” of drugs to midwives on much lower costs. Midwives can send text messages to IBI fordrug needs. IBI can have special rates with the distributors. IBI could establish a broad frameworkcontract with pharmacies/distributors for their members. This scheme would work much better ifmidwives had some money available to hold stocks of needed drugs and supplies rather than dependingon purchasing them when they need them on the spot market. This requires shifting to partial capitationmethod of payment, so that midwives would have a guaranteed income that could be used to purchasesupplies.Some other recommendations include:• Build on the quality assurance efforts being done by BMPK and seek to develop systems inwhich findings can be linked to either regulatory or policy change• Work with IBI to rationalize their investment in Bidan Delima and develop a plan for sustainedmonitoring and evaluation to ensure that midwives are continuing to practice to the establishednorms.• Strengthening the supportive supervision system for midwives94