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

More documents

Recommendations

Info

The team interviewed a manager 16 at one of the K-24 franchises. The manager said because there is nostrict regulation or enforcement by the government on price, some pharmacies charge higher prices onholidays or nights. This has led K-24 to develop a marketing strategy to guarantee their prices will be thesame, night or day. Similarly, as there is little quality control enforced by the local government, K-24 ispositioning itself as vendor of guaranteed good quality drugs.The regional Food and Drug Administration (Balai POM) is responsible for conducting regulatory visitstwo to three times a year. However, informants to the team have stated that it is easy to subvert thisregulatory process, they have either been asked for an in-kind or cash contribution by the inspector orthey have offered it themselves and that results in positive findings.1.9 Stock of Pharmacies and DrugstoresNone of the informants questioned stated that stock-outs were a problem. The current supply chainconsists of manufacturers to sole distributors and then further to the PBF. These secondary distributorssupply the pharmacies and hospitals in Yogyakarta and clients take approximately one month to pay fordrugs.In theory, the PBF distribute prescription medication and OTC (over the counter) drugs to pharmacies andhospitals, while drug stores are only intended to receive over the counter medication. However, this isalso loosely regulated and spot checks found prescription drugs available in drug stores in Yogyakarta.Prices for drugs vary widely and are equally expensive in the public sector as the private sector. TheMinistry of Health has a drug pricing policy called HET (Harga Eceran Tertinggi) which established thehighest prices allowable to charge patients. Most pharmacies, hospital pharmacy departments, and drugsstores sell drugs with a margin of 20-50 percent of the net pharmacy prices.1.10 Staff of Pharmacy and DrugstoresThe requirement of two registered pharmacists per store is in line with the vision of ISFI that a pharmacyshould be a place for professional services where pharmacists provide information on drug efficacy, druginteraction, drug allergies, etc. ISFI has been pushing the local and national government to adopt aregulation that pharmacies are a place for pharmacists’ professional services, not business unit. Undercurrent practice, investors own pharmacies and pharmacists are paid very low wages (about Rp 1-2million a month). 17 Under this model, a pharmacist comes in only one hour a day – or even only 2-3 timesa week – undermining the professional consultation role desired by ISFI.1.11 Dinkes Experience with Private ProvidersThere are limited formal public private partnerships in Yogyakarta. In the cases where private physiciansare treating clients for tuberculosis, they often refer to the public sector for confirmation and observation.Local social health initiatives cover the costs of private providers and midwives stated they did not have aproblem receiving reimbursement from the Dinkes level.16 Personal interview to Ms Ryan, Franchise Department, Head office of K-24 Chain Company.17 Drs, Nunut, ISFI Yogya, Interview62
How can financial incentives be used to improve access to services or qualityof services among private providers?1.12 Experience Contracting through Dinkes or Insurance SchemesAll providers are eligible for receiving contracts, in Yogyakarta both private and public sector heldcontracts. Payment mechanisms are fee for service at pre-set rates or capitation. Despite strongencouragement from the Ministry of Health, Askes has not utilized the DRG system for costreimbursement.Quality of service among private providers remains unregulated. Askes credentialing of private providersin Yogyakarta rests on determining whether they are licensed, their geographic proximity to the clientbase and a visual inspection of the service site. This inspection is not codified against an establishedchecklist of quality standards.1.13 Implementation of AskesAskes is the Social Health Insurance which has been covering civil servants and their family members upto two children since 1968. In addition, Askes covers retired military personnel and their immediatefamily members. Funding comes from a mandatory contribution of 2 percent of monthly basic salary(excluding benefits), matched with an additional 2 percent of salary by the government as an employer.The total number of members nationwide was 14,576,900 insured. 18 The benefit package iscomprehensive health care, including open heart surgery, hemodialysis, and cancer treatment. However,members often have to pay cost-sharing for price differences. 982 drugs are covered under the plan.In the Askes network nationally, there are 11,704 health care providers, including 1,333 private primarycare doctors (who serve as gate keepers) and 811 hospitals, of which 622 are public hospitals and 189 areprivate hospitals. In Yogyakarta, Askes covers 376,543 members served by public and private health careproviders. Askes contracts with all public providers, five private hospitals, all health centers, midwives,and about 400 private primary care physicians (PCP) in Yogyakarta and Central Java. Commercial Askeshas about 100,000 members of 245 companies, including members of local parliaments (DPRD). Monthlycapitation payment per member per month (PMPM) vary from Rp 1,000 to Rp 3,250. Some cancertreatments are excluded or covered in very limited amounts, such as payment only for a small range of thenormal medication used to treat. Reimbursement for a normal labor is 480,000 rupiah, which is more thanunder Jamkesmas. Reimbursement for dialysis is 450,000 rupiah per episode, although Bethesda hospitalclaims that it receives 600,000 rupiah per episode from Askes and that the total is capped at 15 million peryear.In 1993, PT Askes was asked to expand coverage to non-civil servants such as employees in state-runcompanies and private corporations. The Yogyakarta Askes office suggested that the team visit PT DayaManunggal (Damatex), an Integrated Textile Industry, which was just over the border in Salatiga, CentralJava, as a good example of private contracting with Askes. 19 This company has been in operation since1961 and has 6,000 employees, approximately half of which are women. It covers not only employees buttheir dependents, including spouse and two children for an approximate cohort of 16,000.18 Askes Annual Report of 200719 This coverage is called commercial insurance (Askes Komersial). Premium varies by regions and by benefit packages.Accordingly, the benefits vary from limited comprehensive to coverage at international facilities. This commercialinsurance product covers 2,133,269 members of 2,417 corporations nationally.63
Page 1:
PRIVATE SECTOR HEALTHCARE IN INDONE
Page 5:
PRIVATE SECTOR HEALTH CAREIN INDONE
Page 8 and 9:
7. Rationalizing Use of Medications
Page 11 and 12:
ABBREVIATIONSANCAskesAskeskinAusAID
Page 13:
THEUSAIDVATWHOTotal health expendit
Page 17 and 18:
EXECUTIVE SUMMARYAs documented in I
Page 19 and 20:
By using their power to select whic
Page 21:
higher reimbursement for complex de
Page 25 and 26:
2. BACKGROUND2.1 GENERAL BACKGROUND
Page 27 and 28:
While decentralization of the healt
Page 29:
FIGURE 1: TOTAL EXPENDITURES ON HEA
Page 32 and 33:
poor, which only allows use of publ
Page 34 and 35: Lack of overall investment in healt
Page 36 and 37: • Pharmacists and drugsellers - A
Page 38 and 39: 4.2 ASSESSMENT APPROACHData collect
Page 40 and 41: practice, however, limited resource
Page 42 and 43: Dinas to the hospital detailing the
Page 44 and 45: Unlike Muhammadiyah and NU faciliti
Page 46 and 47: TABLE 3: POPULATION COVERAGE BY HEA
Page 48 and 49: customary fees. At the same time, i
Page 51 and 52: 7. RATIONALIZING USE OFMEDICATIONS7
Page 53 and 54: too few medicines to meet the publi
Page 55 and 56: 8. PHARMACISTS ANDDRUGSELLERS AS PA
Page 57 and 58: district provides TB drugs to priva
Page 59 and 60: 9. ROLE OF PROFESSIONALASSOCIATIONS
Page 61 and 62: IMA is involved in any allegations
Page 63 and 64: 10. CONCLUSIONS ANDRECOMMENDATIONSI
Page 65: If Indonesia is to achieve its prio
Page 68 and 69: • Supporting the mapping of all f
Page 71 and 72: ANNEX A: ASSESSMENT GUIDEIndonesia
Page 73 and 74: Key Informants at Provincial LevelK
Page 75: Key InformantsoooIBI, and memberrep
Page 78 and 79: Assessment Question Approach/Backgr
Page 80 and 81: Indicator Number Data Source and No
Page 82 and 83: 1.3.4 DinKes Experience with Privat
Page 86 and 87: They have used many different healt
Page 88 and 89: In Yogyakarta Province, there are 1
Page 90 and 91: graduates to work immediately in 24
Page 92 and 93: Muhammadiyah is a 226 bed hospital
Page 94 and 95: Dinas Yogyakarta31. Mardiningsih, S
Page 96 and 97: 2.1 Provincial InformationThe popul
Page 98 and 99: How can services provided at privat
Page 100 and 101: The Provincial Health Office meets
Page 102 and 103: from multiple sources: 40 percent f
Page 104 and 105: 2.9 Licensing and Oversight of Phar
Page 106 and 107: As per IMA Propinsi, they meet with
Page 108 and 109: It was mentioned that the budget fo
Page 110 and 111: • Private midwives are willing to
Page 112 and 113: etween PKBI and the District Health
Page 114 and 115: Cahya Kawaluyan Hospital has adapte
Page 116 and 117: the midwife to charge a slightly hi
Page 118 and 119: Involving Physicians in DOTS. A sig
Page 120 and 121: Ikatan Bidan Indonesia (IBI) West J
Page 122 and 123: Indicator DKI West Jakarta Data Sou
Page 124 and 125: visited an average of over 60 perce
Page 126 and 127: 3.9 Potential role of professional
Page 128 and 129: members who pay membership fees. Th
Page 130 and 131: emainder paying out of pocket. Reve
Page 132 and 133: 3.20 Indonesian Pharmacists Associa
Page 134 and 135:
OtherApotek Gitamara, Jl. Kemanggis
Page 136 and 137:
13. Government of Indonesia, World
Page 138:
41. Thrabany, Hasbullah, et al. 200
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?