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

By using their power to select which providers to contract with, and enforcing treatmentprotocols with their payment policies, Jamkesmas and other financing mechanisms havepotential to provide incentives for providers (public or private) to improve care andadhere to quality standards. Changes may include paying providers who refer patients whennecessary, or not paying for branded drugs when generic is available. Payment policies can also be usedto target interventions that promote public health (such as providing higher reimbursement for thefourth antenatal care (ANC) visit, or completion of directly observed treatment, short-course (DOTS))Making small changes to Jamkesmas reimbursement policies could significantly improve the quality ofcare, and improve health outcomes.Interventions that incorporate financial incentives to drive provider quality have highpotential for replicability, as Jamkesmas is fully implemented in all districts. Models atdistrict level that demonstrate operational feasibility and document positive health outcomes couldeasily be adopted by other districts, as the Jamkesmas administrative systems are already in place.Investments in technical assistance to the unit managing Jamkesmas within the Ministry of Health mayalso create potential for changes to be adopted as national recommendations.There is little coordination between district health officials and central public healthprograms, or between the district health officials and private providers. While district healthoffices have greater authority over health services within their districts, they do not always have thecapacity and resources to provide effective planning and oversight. There is little coordination withprivate providers to involve them in critical public health programs, such as TB or malaria, or to includethem as referral points. District officials do not have a good understanding of how to interact withprivate providers, and mostly focus on their role as licensor. In some districts, independentorganizations are also active in reviewing service quality and consumer protection. While these groupsare relatively nascent, and would benefit from external technical assistance, they are potentially effectivemodels for external oversight of public and private providers. Improving capacity of district andprovincial health officials to engage with private providers and consumers is critical to improving healthservices.In order to demonstrate the effectiveness of a coordinated effort that includes changingprovider incentives, partnership with private providers, and support to district andprovincial health officials, initial efforts should focus on a limited set of critical healthpriorities. Officials at all levels identify maternal child health (MCH) and TB treatment and control asamong their health priorities, there is information on appropriate treatment standards, and enforcingeffective treatments does not require significant additional funding.If Indonesia is to achieve its priority health objectives, more attention must be paid toengage private sector providers. To improve the quality of private providers and to ensure thatthey contribute to priority health objectives, general recommendations are:• Improve district and province capacity to manage an integrated public-private health system;• Through existing financing schemes, adjust payment policies to provide financial incentives forproviders to improve quality and adhere to standards;• Create partnerships with private sector to address public health priorities such as MCH, TB,and malaria;• Support independent oversight boards and consumer education initiatives;XIX