Issues of Health Services Henni Djuhaeni Medical Faculty of Padjadjaran University HSM Session 4

Learning Objectives At the end of this session, students are expected to:  explain the define of decentralization  explain the Globalization and decentralization of health care  explain the Health care versus politic  explain the MDGs Program  explain Universal Coverage At the end of this session, students are expected to:  explain the define of decentralization  explain the Globalization and decentralization of health care  explain the Health care versus politic  explain the MDGs Program  explain Universal Coverage

Issues of Health Services Health development Decentralization Millennium Development Goals (MDGs) Human Development Index (HDI/ IPM) Human Development Index (HDI/ IPM) Transfer of authority Eradicate extreme poverty and hunger, Promote gender equality and empower women, Reduce child mortality, Improve maternal health, Combat HIV/AIDS, malaria and other diseases Universal Coverage Health Finance System National Health System

BACKGROUND Maternal and child Mortality Rate DEVELOPMENT CHALLENGES OF HEALTH Healthcare finance The access of healthcare services To achieve the target of Millennium Development Goals (MDGs) To increase the roles of healthcare provider, policy maker, manager of healthcare services, insurance agency competency Decentralization Health Politic Health Policy

PEMBANGUNAN ? Suatu proses perubahan yang berkesinambungan di segala bidang kehidupan yang dilakukan secara sengaja berdasarkan suatu rencana tertentu yang bertujuan untuk meningkatkan taraf hidup masyarakat, baik secara spiritual maupun material. RASIONAL BERDASARKAN FAKTA ADA RENCANA PROSES TERKOORDINASI RASIONAL BERDASARKAN FAKTA ADA RENCANA PROSES TERKOORDINASI BERSIFAT POSITIF KEARAH YANG > BAIK BERSIFAT POSITIF KEARAH YANG > BAIK PE STANDAR KEHIDUPAN PRODUKTIFITAS KEDUDUKAN, PERAN DAN KESEMPATAN YG SAMA PE STANDAR KEHIDUPAN PRODUKTIFITAS KEDUDUKAN, PERAN DAN KESEMPATAN YG SAMA TOLOK UKUR 1 1

Health Development ? HEALTH DEVELOPMENT National Health System Health status Indicator: Life Expectancy, Maternal and Child Mortality Rate - Potential measures nation - to increase awareness, willingness and healthy life

INDEKS PEMBANGUNAN MANUSIA (HUMAN DEVELOPMENT INDEX) Adalah sebuah ringkasan perhitungan dari perkembangan manusia. Perhitungan ini merupakan rata-rata keberhasilan pencapaian sebuah negara ditinjau dari tiga dimensi (faktor): UHH, pengetahuan dan GDP perkapita.

HDI (INDEKS PEMBANGUNAN MANUSIA) Long lived and healthy Adult literacy index (score 2/3) Combined gross enrollment ratio (score 1/3) life Expectancy ( average life expectancy in nation) Education Index Human development measures Ability to pay GDP perkapita : bukan unlimited income, tetapi merupakan daftar logaritma dari pendapatan. INDEX

GOALPOSTS Tabel 2.1. Goalposts for HDI measures IndicatorMaximum value Minimum value Life Expectancy/ UHH (year) Adult literacy Index (%) Combined gross enrollment ratio (%) GDP percapita (US $) Sumber: Human Development Report 2005

HDI Measure Actual value – minimum value maximum value – minimum value DEMENTION INDEX =

Life Expectancy Index =Life Expectancy Index Education Index =Education Index  Adult Literacy Index = =(ALI) = Adult Literacy Index  Gross Enrollment Index = (GEI) = Gross Enrollment Index GDP = GDP

Education sector - adult literacy index - Combined GE ratio Education sector - adult literacy index - Combined GE ratio Economic sector Income percapita Economic sector Income percapita Health sector : -LE -Maternal and child mortality Health sector : -LE -Maternal and child mortality double burden of diseases double burden of diseases Health finance problem IPM Health Development National Health System

Decentralization of health as the transfer of responsibility for planning, decision-making, the generation and the use of administrative resources and authority high government level to a lower level in a hierarchical administrative political or territorial 2 2

Desentralization: Regional autonomy Desentralization: Regional autonomy Deconsentration of central government Officials in region Deconsentration of central government Officials in region Devolusion: Political influences Devolusion: Political influences 1.Bringing decision-making 2.Local specific development 3.Potential community empowerment 4.Health status increased 5.Human Development Index (HDI) Indonesia increased 6.Indonesia sehat 2025– “masyarakat mandiri untuk hidup sehat” 1.Bringing decision-making 2.Local specific development 3.Potential community empowerment 4.Health status increased 5.Human Development Index (HDI) Indonesia increased 6.Indonesia sehat 2025– “masyarakat mandiri untuk hidup sehat”

Healthcare finance is sum of money to purchase a range of health care services and products is sum of money to production of health care services Healthcare providerConsumen Government Private +

MDGs Achieve universal primary education Eradicate extreme poverty and hunger Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Promote gender equality and empower women Develop a global partnership for development 3 3 Reduce child mortality Improve maternal health

Economy or Economic, what are you thinking about ?

How about the doctor and hospital ?

(greek = a household management / state) OIKONOMEA ECONOMY ECONOMICS cost containment efficiency Is the science that deals with the cosequences of resource scarcity Health economic deals with the cosequences of resource scarcity in the health care industry

Health care finance problems ? No access to health care provider/ services Health care finance problems Cost of Heath services Scarcity of the health budget -Fee for services - supply induced demand -Administration fee increased -Fee for services - supply induced demand -Administration fee increased Community participation OUT OF POCKET insurance

Universal Coverage 2014 Seluruh masyarakat dapat akses terhadap pelayanan kesehatan bermutu sesuai kebutuhan dasar dan kebutuhan medik tanpa membeda-bedakan tingkat penghasilan, status sosial dan tempat tinggal. Sumberdana dapat melalui pajak, asuransi dan dikelola dengan skema nasional atau beberapa skema yang berbeda. Seluruh masyarakat dapat akses terhadap pelayanan kesehatan bermutu sesuai kebutuhan dasar dan kebutuhan medik tanpa membeda-bedakan tingkat penghasilan, status sosial dan tempat tinggal. Sumberdana dapat melalui pajak, asuransi dan dikelola dengan skema nasional atau beberapa skema yang berbeda. Nitayarumphong & Mills 4 4

THE HEALTH CARE TRIANGLE Third party insurer or purchaser Citizen Provider (PPK) delivery funding allocation EKSEKUTIF, LEGISLATIF, BADAN INDEPENDEN MONITORING The provision and financing of health care can be simplified as an exchange or tranfer of resources

SUMBER PEMBIAYAAN PEMERINTAH -PEMERINTAH PUSAT -PEMERINTAH DAERAH PROPINSI -PEMERINTAH DAERAH KAB/ KOTA PEMERINTAH -PEMERINTAH PUSAT -PEMERINTAH DAERAH PROPINSI -PEMERINTAH DAERAH KAB/ KOTA SWASTA/ MASYARAKAT - PERUSAHAAN/ PEMILIK - ASURANSI KESEHATAN SWASTA - PENGELUARAN RUMAH TANGGA - SUMBANGAN SOSIAL - COMMUNAL SELF-HELP - PERUSAHAAN/ PEMILIK - ASURANSI KESEHATAN SWASTA - PENGELUARAN RUMAH TANGGA - SUMBANGAN SOSIAL - COMMUNAL SELF-HELP - PAJAK SECARA UMUM - PAJAK PENJUALAN - BANTUAN / PINJAMAN LUAR NEGERI - ASURANSI SOSIAL - PAJAK SECARA UMUM - PAJAK PENJUALAN - BANTUAN / PINJAMAN LUAR NEGERI - ASURANSI SOSIAL

KEBIJAKAN PEMERINTAH ? UNDANG – UNDANG SISTEM JAMINAN SOSIAL NASIONAL (SJSN, 2004) DILAKUKAN SECARA BERTAHAP DALAM KURUN WAKTU 30 TAHUN

ASKES SOSIAL ? Bukan gratis, tapi : - Sifatnya wajib - Premi : % pendapatan - Yankes sama - Bagi yg miskin, premi dibayar Pemerintah SAKIT MISKIN BESAR TUA

3 PILAR PEMBANGUNAN SISTEM JAMINAN SOSIAL NASIONAL SOCIAL ASSISTANCE : Jamkesmas, jamkesda, Jampersal, Bawaku Sehat -Orang miskin -Tidak mampu -Penghasilan tidak tetap Social insurance Suplemen Insurance -Compulsary -Seluruh penduduk berpenghasilan -Jaminan > -Jaminan privat -Jaminan kesejahteraan -Memenuhi kebutuhan dasar yg layak - Need Pemenuhan want, demand