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

emainder paying out of pocket. Revenue from GAKIN patients is approximately Rp 1.2 billion permonth, compared with support from Dinas of approximately Rp 25 – 50 million per month prior toGAKIN. Implementation of GAKIN has resulted in an overall higher budget for the hospital.The team visited St Carolus Hospital, a 366 bed Catholic-affiliated hospital, with 35 percent Class IIIbeds. It estimates that approximately 15 percent of its patents are GAKIN patients, another 30 percent arecovered by commercial insurance, and 10-15 percent are covered under direct employer contracts. Theremainder of patients (40-45 percent) pay directly out of pocket. The hospital is generally recognized forhigh quality MCH services, and has a special package fee for referrals from private midwives. However,Puskesmas would not refer GAKIN or Jamkesmas patients to St Carolus.Providers report that it takes a long time to be reimbursed through GAKIN – during our visit the firstweek of June, Sumber Waras Hospital and RSIJ Cempaka Putih Hospital reported the GAKIN had notpaid claims since November 2008. Both hospitals also reported that Askes and Jamsostek reimburses inapproximately one month. St Carolus Hospital reported that 3-4 month delay in payment from GAKIN isnormal. However, the Cengkareng District Hospital had been paid through March 2009. Both CempakaPutih and St Carolus believed that reimbursements by GAKIN are below hospital cost, with St Carolusestimating that they only 50-60 percent of actual costs.3.15 Implementation of Askes and JamsostekBoth Askes and Jamsostek are important payers for health services. They are both considered toreimburse at rates above GAKIN and Jamkesmas, and are more reliable for timely reimbursement,generally within one month.Three of the four hospitals visited had contracts with Askes and Jamsostek to serve their members, with theexception being St Carolus, who implied that they expected to have such contracts in the future. CengkarengHospital received 10 percent of its revenues from Askes, and 18% from Jamsostek. Cempaka Putih estimatedthat approximately 30 percent of its revenues are from Askes and Jamsostek.Puskesmas Cengkarang reported that the capitation payment from Jamsostek is Rp 1,750 per capita, whichincludes consultation, MCH, FP, and drugs. There is a reimbursement schedule for other services that arenot part of the capitation package. They also reported that approximately 25 percent of the Askes patientscome solely to get a referral letter, and do not want any treatment.3.16 Implementation of JamkesmasIn DKI Jakarta, ensuring access for the poor and near poor is implemented through the GAKIN scheme.Jakarta province chose to implement its own scheme, rather than relying on Jamkesmas. GAKIN benefitsare only provided to low income population, who are official residents of Jakarta. People who are notofficial residents would access the Jamkesmas card in order to get access to health services.The reach of Jamkesmas in covering the population that lives in Jakarta, but are not official residents, isunclear. Three of the hospitals visited reported that Jamkesmas represented a small share of its patients,while St Carolus Hospital had no agreement to provide services for Jamkesmas patients.The private midwives in West Jakarta do not accept Jamkesmas or GAKIN through their private practices.The reason given by the district IBI leaders were that there is no contract between the government andprivate providers, and they have never received notice that they could be reimbursed by Jamkesmas in theirprivate facilities. During a group discussion with midwives, they also responded that the reimbursement by108