Healthcare System in Indonesia

and other countries: what’s the

common pattern?

I Nyoman Sutarsa
Department of Community and Preventive Medicine
Ph. +6207860380028
Email: sutarsa84@gmail.com
 Intro…
The goal of the health systems is to
achieve optimal and equal health status.
Health status has improved dramatically
over the last decades. MMR, IMR, life
expectancy and mortality due to
infectious diseases has also fallen
significantly over the last decades.
However, inequities of health access
remains in most countries …
 Structure
• Types of health care system
• Health care system in Indonesia
• Health care system in Canada
• Health care system in the Philippines
• Common pattern?
 Types of HCS

Role of government?
Totalitarian Financing?

Combination of those two

Liberal Indonesia??
Health Care System Indonesia
Country Profiles:
• Total population > 215 million
• Population density 111 (person per
square km)
• Population growth rates 1.21
• Urban population 41%
• Over 65 yo population around 1%
• Sex ratio of 0,78
Health Care System Indonesia
Health Profiles (selected issues):
• Crude birth rates is 20
• Crude death rates 7.1
• Maternal mortality rate 358???
• Total fertility rate 2.4
• Life expectancy: males 64.4 years and
females 67.4 years
Health Care System Indonesia
Economic Profiles (selected):
• GNI of 596 billion
• Health expenditure is about 2.7% GDP
Health Care System Indonesia
Healthcare System Financing:
• Public (national and local governments)
• Private (profit and non profit)
• Foreign aid
• In 2014  UC with National Health
Insurance (using Capitation Model)
Health Care System Indonesia
Service Delivery Models:
• National to village levels
• Posyandu (Integrated Health Posts) in
every villages
• CHC in every sub-district
• District hospital
• Provincial hospital – referral hospital
• 2014  PC Doctor (FM/GPs)
• Various private health services
Health Care System Indonesia
Human Resources:
• Around 380,000 health workers (17% at
national level)
• Around 150,000 government doctors,
nurses and midwives (account for 60% of
total health budget)
• Nurses and midwives 41.4%
• Medical doctors 4.7%
• Specialist 1.9%
Health Care System Indonesia
Priority Issues moving forward:
• Inequalities in health access
• Decentralisation
• UC
• High quality governance
• Mal-distribution
• Deregulation of drug trade (> generic)
• Service integration
 Health Care System Canada
Country Profiles:
• Total population > 34,1 million
• Population density 3.8 (person per
square km)
• Population growth rates 1.1
• Urban population 80.6%
• Over 65 yo population around 14%
• Sex ratio of 0,98
 Health Care System Canada
Health Profiles (selected issues):
• Crude birth rates is 11.2
• Crude death rates 7.4
• Maternal mortality rate 12
• Total fertility rate 1.7
• Life expectancy: males 78.4 years and
females 83 years
 Health Care System Canada
Economic Profiles (selected):
• GNI per capita 35,166 USD
• Health expenditure is about 3,900 USD
 Health Care System Canada
Healthcare System Financing:
• Public (national and local governments)
account for 70%  tax revenues
• Private is only 30% (OOP and PHI)
• 43% of health expenditure is allocated
to hospitals and physicians
 Health Care System Canada
Service Delivery Models:
• Public health services (government)
• Primary or ambulatory care
• Inpatient care and or specialised care
• Emergency care
• Pharmaceutical care  community
pharmacist
• Rehabilitation or inter-mediate care
• Plus Aboriginal health services
 Health Care System Canada
Human Resources:
• Nurses 9.39 (per 1000 population)
• PC Doctors 1.12 (per 1000 population)
• Specialist 0.89 (per 1000 population)
• Various density of health workers
across regions
• Professional mobility of health workers
(going abroad or coming in)
 Health Care System Canada
Priority Issues moving forward:
• Demographic ageing
• Rural and remote communities
• Immigration
• Unique rights (Aboriginal peoples)
• Decentralisation vs centralisation
• Inter-sectorality
• Patient empowerment
Health Care System Philippines
Country Profiles:
• Total population > 94 million
• Population density 260 (person per
square km)
• Population growth rates 2.0
• Urban population 50.3%
• Over 65 yo population around ???
• Sex ratio of 1.01
Health Care System Philippines
Health Profiles (selected issues):
• Crude birth rates is 20.1
• Crude death rates 5.1
• Maternal mortality rate 162
• Total fertility rate 3.3
• Life expectancy: males 67-69 years and
females 74 years
Health Care System Philippines
Economic Profiles (selected):
• GNI of 7.7 billion
• Health expenditure is about 3.9% GDP
Health Care System Philippines
Healthcare System Financing:
• Private > public
• OOP > 48%
• Public (national and local governments)
up to 41%
• Social health insurance scheme
• Private sources (including PHI)
• NHI  PhilHealth
Health Care System Philippines
Service Delivery Models:
• Private > 30% population
• National to municipality levels
• Provincial level  tertiary care
• District level  public goods
• Various vertical programs
• RHUs (Rural Health)
Health Care System Philippines
Human Resources:
• >> nurses and midwives
• Government and private sectors
• Professional mobility health workers ??
Health Care System Philippines
Priority Issues moving forward:
• Inequalities in health access
• Decentralisation
• UC
• High quality governance
• Mal-distribution
• P-P Partnership
• Service integration
 What is the game changer?
• The healthy paradigm  emphasising health
promotion and preventative measures
• Professionalism
• The community managed healthcare program
 encourage community participation and
empowerment
• Effective decentralisation
• Universal coverage through national health
insurance scheme
• Service integration
• Encourage P-P Partnership