PEMBIAYAAN

KESEHATAN
Juanita
D:\bakul\health ec
and finance\HEALTH FIN

D:\bakul\health ec
and finance\UGM_The Re
• Financing
Budgetting
• Expenditures Funding
• Spending Expenses
• Costing Incentives
• Paying/payment
Sistem Kesehatan (WHO, 2000) :
• Seluruh kegiatan yang dilakukan dengan tujuan untuk
meningkatkan dan memelihara kesehatan yang
mencakup pelayanan kesehatan formal dan non
formal.
• Menyangkut promosi kesehatan, pencegahan
penyakit, peningkatan keamanan lingkungan, dan
• pendidikan yang berhubungan dengan kesehatan.
Tujuan :

• Peningkatan status kesehatan

• Perlindungan resiko terhadap biaya
kesehatan (UHC)
• Kepuasan publik
Fungsi Sistem Kesehatan (WHO,
2000)
Kerangka Kerja Sistem Kesehatan
(WHO, 2007)
Health Financing
SKN 2012 :
1. SUBSISTEM UPAYA KESEHATAN
2. SUBSISTEM PENELITIAN DAN PENGEMBANGAN
KESEHATAN
3. SUBSISTEM PEMBIAYAAN KESEHATAN
4. SUBSISTEM SUMBER DAYA MANUSIA KESEHATAN
5. SUB SISTEM SEDIAAN FARMASI, ALAT KESEHATAN, DAN
MAKANAN
6. SUBSISTEM MANAJEMEN, INFORMASI, DAN REGULASI
KESEHATAN
7. SUBSISTEM PEMBERDAYAAN MASYARAKAT
Subsistem pembiayaan
kesehatan
pengelolaan berbagai upaya penggalian,
pengalokasian, dan pembelanjaan dana
kesehatan untuk mendukung
penyelenggaraan pembangunan kesehatan
guna mencapai derajat kesehatan masyarakat
yang setinggi-tingginya
• Health financing refers to the “function of a
health system concerned with the mobilization,
accumulation and allocation of money to cover
the health needs of the people, individually and
collectively, in the health system…
• the purpose of health financing is to make
funding available, as well as to set the right
financial incentives to providers, to ensure that
all individuals have access to effective public
health and personal health care” (WHO 2000).
 Fungsi dan Tujuan Pembiayaan Kesehatan
fungsi tujuan
Revenue Meningkatkan dana untuk kesehatan D:\bakul\health ec
and finance\trisnantor
Collection secara cukup dan berkesinambungan.
Dana ini untuk membiayai pelayanan
paket esensial dasar dan perlindungan Microsoft Word 97

keuangan dari penyakit dan kecelakaan

- 2003 Document

yang membangkrutkan berdasarkan

aspek pemerataan
Pooling Mengelola dana-dana tersebut dalam
D:\BL\JKN Sumut
2016\kurniawan_Monev JKN

pool risiko kesehatan yang efisien dan

merata
Purchasing & Menjamin pembelian/pemerolehan
Payment dan pembayaran pelayanan
kesehatan yang efisien secara teknis
dan alokatif
 1. Total expenditure on health as % of
GDP
The percentage of gross domestic product (GDP) spent on health is
a measure of the share of a country’s total income that is allocated
to health by all public, private, and donor sources.
A standard measure used for international comparisons, this
indicator typically ranges between 2 and 15 percent of GDP spent on
health.
An extremely low percentage of GDP spent on health suggests that
not enough resources are mobilized for health, that access to health
care is insufficient, and that the quality of services is poor.
An extremely high expenditure suggests a widespread use of high
technology and likelihood of inefficiencies.
There are, however, no commonly accepted benchmarks or targets
for an appropriate percentage of GDP that a country should spend
on health.
Produk Domestik Bruto(PDB=GDP) adalah nilai pasar semua barang dan
jasa yang diproduksi oleh suatu negara pada periode tertentu.
PDB merupakan salah satu metode untuk menghitung pendapatan
nasional dan pendapatan suatu daerah tertentu.
PDB diartikan sebagai nilai keseluruhan semua barang dan jasa yang
diproduksi di dalam wilayah tersebut dalam jangka waktu tertentu
(biasanya per tahun).
PDB berbeda dari produk nasional bruto karena memasukkan
pendapatan faktor produksi dari luar negeri yang bekerja di negara
tersebut.
PDB hanya menghitung total produksi dari suatu negara tanpa
memperhitungkan apakah produksi itu dilakukan dengan memakai faktor
produksi dalam negeri atau tidak.
Sebaliknya, PNB memperhatikan asal usul faktor produksi yang
digunakan.
PDB Nominal merujuk kepada nilai PDB tanpa memperhatikan pengaruh
harga. Sedangkan PDB riil <!-(atau disebut PDB Atas Dasar Harga
Konstan)--> mengoreksi angka PDB nominal dengan memasukkan
pengaruh dari harga
2. Per capita total health expenditure, at average
exchange rate (USD)
This indicator reflects the average amount of resources spent on
health per person.
It is another standard measure that can indicate whether
spending on health is adequate to achieve appropriate access
and quality.
According to the report of the Commission on Macroeconomics
and Health (WHO 2001), providing minimal essential health care
services would require expenditure in 2007 of at least 34 U.S.
dollars (USD) per capita per year in low-income
countries.
Countries with relatively low per capita spending (e.g., below
USD 30 per capita) are likely to have poor access, a low quality
of health care, or both.
3. Government expenditure on health as %
of total government expenditure

• This indicator illustrates the commitment of government to

the health sector relative to other commitments reflected
in the total government budget.
• The allocation of government budget to health is subject
to political influences and judgments about the value of
health spending relative to other demands for public
sector spending.
• A relatively large commitment of government spending to
health (e.g., above 20 percent) suggests a high
commitment to the sector.
4. Public (government) spending on health
as % of total health expenditure
• This indicator is a measure of the relative contribution of
central and local government, relative to total health
spending.
• If the percentage is relatively low (i.e., below 40 percent) it
can reflect :
• (1) a low tax capability of the country’s government,
• (2) a philosophy of a limited role for government in
• health (i.e., that public spending should not play a large
role in financing or providing health services for the
population), or
• (3) both. A low value for this indicator also means that the
government has limited ability to act to address equity
issues.
5. Donor spending on health as % of total
health spending

• The share of total health spending financed by donors

measures the contribution of international agencies and
foreign governments to total health spending.
• A very high donor contribution to a country’s total health
spending (e.g., above 10 percent) is a concern for
financial and possibly institutional sustainability if the
donor contributions are withdrawn.
• Compare this indicator to government health
spending as a percentage of total health spending
(indicator 4) to assess the sustainability
implications of the share of donor spending.
• Very high donor health spending suggests that the
• government would have to increase its health
spending by a large proportion to replace donor
contributions, should they be withdrawn, to avoid
placing the burden on private spending.
6. Out-of-pocket spending as % of private
expenditure on health

This indicator represents the expenditures that

households make out of pocket at the time of using
health care services and purchasing medicines,
relative to total private spending on health.
Out-of-pocket expenditures exclude payment of
insurance premiums, but include nonreimbursable
insurance deductibles, co-payments, and fees for
service.
Indonesia :
the proportion of health spending to GDP remains
below average among the low-to-middle-income
countries, accounted for 2.8% of GDP in 2014
according to WHO database (WHO, 2017) or 3.6%
based on the 2014 NHA Indonesia country report
(MoH et al., 2015).
with a public share of only 37.8% of total health
expenditure, whereas private, primarily OOP
payments, contribute 62.2%
Mekanisme Revenue Collection

Melalui mekanisme pemerintah/lembaga asuransi kuasi

pemerintah
• Pajak langsung atau tidak langsung
• Pendapatan pemerintah yang berasal dari bukan pajak
• Kontribusi asuransi wajib dan potongan gaji
• Pembayaran premi ke pemerintah
• Grant dan pinjaman luarnegeri

Dari masyarakat
• Dari kantong pasien perorangan
• Yayasan-yayasan kemanusiaan
Pooling the Risk :
•Pooling yaitu bagaimana pengumpulan dana
dibagikan yang mempunyai risiko kesehatan
diantara pengumpul dana /atau anggota kelompok
(pool member) (World Bank, 2014).
•Dana yang dikumpulkan untuk kesehatan akan
dibayarkan ke provider kesehatan, • tempat
penampungan (pools) dana bisa berbagai macam,
seperti anggaran pemerintah pusat dan
pemerintah daerah, asuransi kesehatan publik dan
swasta, dan asuransi kesehatan berbasis
masyarakat.
Purchasing:
Mekanisme pembayaran ke fasilitas
kesehatan dan penyedia layanan kesehatan
3 komponen yaitu alokasi sumber daya,
paket manfaat dan mekanisme pembayaran
provider (Preker and Langenbrunner, 2005)

merupakan komponen kunci yang sangat

penting untuk pemerataan akses yang adil dan
perlindungan terhadap resiko keuangan.
DEFINITION OF HEALTH EXPENDITURE

• Health spending consists of health and health-related

expenditures. Expenditures are defined on the basis of
their primary or predominant purpose of improving health,
regardless of the primary function or activity of the entity
providing or paying for the associated health services.
• Health includes both the health of individuals as well as of
groups of individuals or population.
Health expenditure consists of all expenditures or
outlays for medical care, prevention, promotion,
rehabilitation, community health activities, health
administration and regulation and capital formation with
the predominant objective of improving health.
• Health-related expenditures include expenditures on
health-related functions such as medical education
and training, and research and development.

• PUBLIC EXPENDITURE ON HEALTH

• Public expenditure on health refers to expenditure
on health care incurred by public funds. Public funds
are state, regional and local Government bodies and
social security schemes. Public capital formation on
health includes publicly-financed investment in
health facilities plus capital transfers to the private
sector for hospital construction and equipment.
Public funds correspond to HF.1 in the ICHA-HF
classification of health care financing.
Health costing
several other approaches for costing

• such as costing for pricing decision or cost of illness

studies as part of the priority setting exercise (Gyldmark
1995, Kernick 2000).
 costing studies could focus on one of the following
options:
• Comparing the (unit) costs of particular services (e.g. GP
visits, cataract surgery, colonoscopy) or
• Comparing costs of treatment episodes (e.g. ambulatory DRG,
inpatient DRG, costs of the treatment of common flu, costs of first
psychotic episodes, etc. ) or
• Comparing the annual total costs of particular services (e.g.
the total costs of specialist pain clinic or costs of stroke unit per
year)
• Cost of illness for a given time period (e.g. low back pain
treatment in primary care in the first month or stoke treatment for
the first year). This comparison may be more comprehensive and
can avoid or uncover cost shifting (day hospital and informal care)
Budgetting/anggaran
• suatu rencana yang disusun secara
sistematis, yang meliputi seluruh kegiatan
perusahaan, yang dinyatakan dalam unit
(kesatuan) moneter dan berlaku untuk jangka
waktu (periode) tertentu yang akan datang
(Munandar, 2002),
• suatu rencana yang disusun secara sistematis
dalam bentuk angka dan dinyatakan dalam
unit menoter yang meliputi seluruh kegiatan
perusahaan untuk jangka waktu (periode)
tertentu di masa yang akan datang.
• pernyataan mengenai estimasi kinerja
yang hendak dicapai selama periode
waktu tertentu yang dinyatakan dalam
ukuran finansial.
• Anggaran adalah suatu pendekatan
yang formal dan sistematis dari
pelaksanaan tanggung jawab
manajemen di dalam perencanaan,
koordinasi dan pengawasan
• “Budgeting menunjukkan suatu proses, sejak
dari tahap persiapan yang diperlukan sebelum
dimulainya penyusunan rencana,
pengumpulan berbagai data dan informasi
yang diperlukan. Pembagian tugas
perencanaan, penyusunan rencana itu sendiri,
implementasi dari rencana tersebut, sampai
pada akhirnya tahap pengawasan dan evaluasi
dari hasil-hasil pelaksanaan rencana.”
Batasan Pembiayaan Kesehatan
Besarnya dana yang harus dikeluarkan untuk
menyelenggarakan dan atau memanfaatkan
berbagai upaya kesehatan yang diperlukan oleh
perorangan, keluarga, kelompok, dan masyarakat.

Health provider Health consumer

Cara-cara pembayaran/paying

• Out of pocket (OOP) : keluar dari kantong sendiri

• Perusahaan: tempat pasien bekerja
• Asuransi: pasien yang menjadi peserta asuransi
• Charity: sumbangan dari individu atau lembaga
sosial
• Pemerintah: alokasi anggaran untuk pelayanan
publik