Indonesia has highest population after China, India, and USA, with a population of over 270 million people. The country's healthcare system has significantly developed in the past few decades, with efforts to improve healthcare access and quality across the archipelago. The government is spending 3% of its GDP on health care, less than other countries.
The life expectancy was 63 years in 1990 and increased to 71 years in 2012. Infant mortality was reduced from 41 deaths per 1,000 live births to 26 deaths in 2012. However, the improvements in maternal mortality and infectious diseases were slower.
STRUCTURE OF INDONESIA'S HEALTHCARE SYSTEM
Indonesia's healthcare system is divided into two main sectors: the public and the private sector.
The Ministry of Health manages the public sector and includes government-run hospitals, community health centers (Puskesmas), and public health programs. Public healthcare is decentralized and is managed at three different levels, central,
provincial and district government responsibilities.
The central Ministry of Health is responsible for managing tertiary and specialty hospitals, setting standards and regulations, and ensuring the availability of financial and human resources.
Provincial governments are responsible for maintaining provincial hospitals, providing district-level services, and managing cross-district health issues.
District governments maintain district hospitals, community health centers, and sub-district facilities.
The private sector includes private hospitals, clinics, and individual practitioners.
The public sector healthcare providers are divided into primary, secondary, and tertiary. Primary healthcare is delivered through community health centers (Puskesmas), which provide essential health services such as vaccinations, antenatal care, family planning, and health education. Secondary healthcare is provided by district hospitals, while referral hospitals provide tertiary care.
Indonesia is aiming to achieve universal health care. In 2014, Badan Penyelenggara Jaminan Sosial Kesehatan, a social security agency, was launched to provide universal health care. The universal healthcare system was called the Jaminan Kesehatan Nasional. The program includes salaried individuals, non-receiving wage workers and nonworkers, and health insurance contribution assistance beneficiaries.
There are both private and public providers in Indonesia. General hospitals are involved in providing health services across all therapy areas and diseases, whereas specialty hospitals are engaged in providing services to a particular condition. The specialty hospitals are classified as Class A, B, C, and D based on the number of inpatient beds.
Delivery of health care services:
The primary point of contact between the patient and healthcare services is the primary care facilities, puskesmas, and their networks. The referrals are required for the patient to attend the hospital or specialty clinic, except in emergencies. Puskesmas are involved in curative and public health services, including health promotion, prevention of infectious diseases, ambulatory care, maternal and child health, family planning, and community nutrition.
Patients who attend the hospitals without referrals pay out-of-pocket.
The healthcare system in Indonesia is organized into three tiers
Primary healthcare: This tier provides essential healthcare services, such as preventive care, health education, and treatment of minor illnesses and injuries. Primary healthcare is typically provided by community health centers (puskesmas) and private clinics.
Secondary healthcare: This tier provides more specialized services, such as surgery, obstetrics, and emergency care. District hospitals and private hospitals typically provide secondary healthcare.
Tertiary healthcare: This tier provides highly specialized services like organ transplantation and cancer treatment. Referral hospitals and specialized private hospitals typically provide tertiary healthcare.
In addition to these tiers, traditional medicine, and alternative therapies are also commonly used in Indonesia and recognized by the government as complementary healthcare.
In Indonesia, the process for drug approval is overseen by the National Agency of Drug and Food Control (BPOM). The agency evaluates drugs' safety, efficacy, and quality before they can be marketed and distributed in the country.
The drug approval process in Indonesia typically involves the following steps:
Submission of application: The drug manufacturer or sponsor submits an application to BPOM with detailed information about the drug, including its composition, manufacturing process, and clinical trial data.
Evaluation of application: BPOM evaluates the application and assesses the drug's safety, efficacy, and quality. The agency may request additional information or data from the manufacturer or sponsor during the evaluation process.
Clinical trials: If the drug has not been approved for use in other countries or if BPOM deems it necessary, the manufacturer or sponsor may be required to conduct clinical trials in Indonesia to evaluate the drug's safety and efficacy further.
Approval decision: Once BPOM has completed its evaluation and is satisfied with the safety, efficacy, and quality of the drug, it will issue approval for the drug to be marketed and distributed in Indonesia.
Post-marketing surveillance: BPOM monitors the safety and effectiveness of drugs approved and marketed in Indonesia. BPOM may suspend or revoke the drug's approval if any safety concerns arise.
It's important to note that the drug approval process in Indonesia can be lengthy and complex and vary depending on the type of drug and its intended use. It is recommended that drug manufacturers or sponsors consult with BPOM early in the drug development process to ensure that they are meeting all requirements and regulations.
DRUG PRICING AND REIMBURSEMENT
In Indonesia, the Social Security Agency for Health (BPJS Kesehatan) manages the reimbursement of drugs through its National Health Insurance program. The program provides access to healthcare services and medications to all Indonesian citizens and legal residents registered as program members.
The reimbursement process for drugs in Indonesia under the National Health Insurance program typically involves the following steps:
Formulary listing: The National Formulary Committee (Komisi Formularium Nasional) maintains a list of drugs eligible for reimbursement under the National Health Insurance program. The committee evaluates drugs' safety, efficacy, and cost-effectiveness before adding them to the list.
Prescription and dispensing: A National Health Insurance program member visits a healthcare facility and receives a prescription for a drug listed in the National Formulary. The medication is then taken to a pharmacy or drugstore for dispensing.
Reimbursement: The pharmacy or drugstore submits a claim for reimbursement to the National Health Insurance program on behalf of the member. The claim includes details of the drug, dosage, and cost.
Payment: The National Health Insurance program processes the claim and pays the pharmacy or drugstore for the cost of the drug, minus any co-payments or deductibles that may apply.
It's important to note that not all drugs are eligible for reimbursement under the National Health Insurance program. The reimbursement level may vary depending on the drug and the member's coverage level. It is recommended that members of the program consult with their healthcare providers or the National Health Insurance program for more information on the reimbursement of drugs.
CHALLENGES IN INDONESIA'S HEALTHCARE SYSTEM
Despite efforts to improve healthcare access and quality in Indonesia, the healthcare system still faces several challenges. These include:
Limited access to healthcare: Healthcare services are often concentrated in urban areas, leaving those in rural and remote areas with limited access to healthcare services.
Shortage of healthcare workers: Indonesia needs more healthcare workers, particularly in rural and remote areas. This shortage is due to inadequate training facilities, low wages, and poor working conditions.
Funding limitations: Indonesia's healthcare system relies heavily on government funding, which is often limited. This limits the government's ability to invest in healthcare infrastructure and services.
Inadequate infrastructure: The country's healthcare infrastructure needs to be improved, particularly in rural and remote areas. Many healthcare facilities need more basic equipment and supplies, and there are shortages of hospital beds, medical equipment, and medicine.
Despite several challenges, the Indonesian government has implemented several initiatives to improve healthcare access and quality in the country. These include:
Universal Health Coverage: In 2014, the Indonesian government introduced a national health insurance program called Jaminan Kesehatan Nasional (JKN). It aims to provide universal health coverage to all Indonesians by 2019, with the government covering health services for the poor and vulnerable.
Health Infrastructure Development: The government has invested in healthcare infrastructure development, including the construction of new hospitals, clinics, and community health centers in rural and remote areas.
Healthcare Worker Training: The government has also invested in healthcare worker training and education, focusing on training more healthcare workers and improving the skills of existing healthcare workers.
Health Promotion and Prevention: The government has implemented several health promotion and prevention programs, including vaccination programs, family planning initiatives, and health education campaigns.