Health Finance & Governance Project Trip Report

The mission was led by Karishmah Bhuwanee, Resource Tracking Advisor for the Health Finance and Governance project, in collaboration with the University of Indonesia's Center for Health Economics and Policy Studies (UI-CHEPS). The primary objective of the mission was to provide technical support to the Health Financing Unit of the Ministry of Health (PPJK) in producing the 2015 Health Accounts (HA) and 2016 HA, as well as to facilitate a crosswalk between national and district-level Health Accounts. The PPJK sought to strengthen its technical capacity to interpret and analyze HA data effectively, enabling policymakers to inform policy and strategic plans. During the mission, Bhuwanee presented examples of how HA results can be used to make health financing decisions at the district level to a 3-day meeting of District Health Offices in Jogyakarta. The PPJK and UI team also discussed technical issues related to completing the 2016 HA and potential ways forward for the crosswalk between national and district-level Health Accounts. Key accomplishments of the mission include the completion of a policy brief using 2015 HA results, the identification of challenges for a crosswalk between national and sub-national Health Accounts, and the agreement to support 7 pilot districts to produce Health Accounts and increase their capacity to track health spending. A major challenge encountered during the mission was the lack of sufficient utilization data from the Social Health Insurance Agency (BPJS) to calculate distribution keys. Additionally, the data available to break down health spending showed 85% of social health insurance spending for hospital outpatient care coded as "unclassified," which may be due to hospitals using this classification to obtain reimbursement for repeat visits. Next steps include the completion of the draft policy brief on health prevention spending by the UI team, with a final technical review by HFG; validation of the 2015 Health Accounts results by PPJK through an inter-ministerial committee; and support for coding for 2016 Health Accounts by HFG remotely and via a TDY expected in July. The UI team will also draft the methodology document outlining how Health Accounts are produced in Indonesia, with feedback from HFG.