National Health Account Indonesia: Achievements and Challenges

The NHA is a global standard for tracking and comparing health expenditure across countries. In 2015, Indonesia's health expenditure per capita was USD 122, which is among the lowest in the Association of Southeast Asian Nations (ASEAN). The composition of health expenditure in Indonesia is dominated by out-of-pocket payments, accounting for 56.7% of total health expenditure in 2016. The public sector contributes 40.7% of total health expenditure, while the private sector accounts for 59.3%. The social health insurance scheme, known as JKN, covers 195 million members and accounts for 15% of total health expenditure. The Ministry of Health's policies emphasize the improvement of the role of primary care as a gatekeeper, with an effective referral system and ability to provide healthcare delivery for up to 155 diagnoses. The payment scheme to providers was changed from a 'fee for service' mechanism to a 'prospective payment' system in an effort to further improve healthcare. Health spending in Indonesia is mostly for rehabilitative curative services, inpatient care, and outpatient care. There has been no fundamental change in the proportion of health spending before and after the implementation of JKN. However, there has been an increase in health spending on preventive care, from 1.8% in 2010 to 5.7% in 2015. The growth of private hospitals in Indonesia has been rapid, with 21,700 primary care facilities and 2,200 hospitals as of April 2018. The majority of health spending included in Health Care Providers (HP) are from hospitals, accounting for 51.4% of total health expenditure in 2015. The proportion of preventive care shows a significant increase to 3.1% of total health expenditure in 2015 compared to the previous 1.8% in 2010. The Indonesian government has set a target to allocate at least 5% of the total central budget for health, excluding salaries, as required by Regulation UU 36 Year 2009. The government's commitment to the health sector is reflected in the allocation of resources, with a focus on improving the quality and accessibility of healthcare services.