Sharpening the Focus on the Poor: Policy Options for Advancing Social Health Protection in Indonesia

Abstract

Currently some 60 per cent of the Indonesian population is excluded from social health protection and a large part of total health care costs is financed by out-of-pocket payments. Existing schemes are generally under-funded and weakened by opt-out-possibilities. In addition, a high amount of public health expenditure is spent on supply side financing, which often is not responding to the needs of the poor. This situation led to strong links between ill health and poverty: within Indonesia considerable variations of health indicators are observed between people living in rich and poor provinces and in urban and rural areas. The Indonesian Government decided to challenge the negative effects of lacking social health protection by introducing a national social health insurance scheme. The new scheme intends to achieve universal coverage within a timeframe of 20 to 30 years. The study recommends that the extension of social health protection to the poor be advanced through various policy options. They include privileged implementation of related features of the new social health insurance scheme, strengthening consensus building on pro-poor policies among key stakeholders in social health protection and setting priorities on implementing these policies. In addition, the implementation of innovative social health protection schemes suitable to informal sector workers, such as flexible community-based schemes, should be taken into consideration. Innovative schemes should offset financial barriers to access health services. They should be based on solidarity between the healthy and the sick and apply main principles of social health insurance. Furthermore, it is suggested to develop links and bridges between the national social health insurance scheme and the innovative schemes in order to reach coherent and comprehensive social health protection overcoming the current exclusion of the poor.