The Republic of Indonesia Health System Review - WHO

1 The Republic of IndonesiaHealth System ReviewHealth Systems in TransitionVol. 7 No. 1 2017 Health Systems in Transition Vol. 7 No. 1 2017 The Republic of Indonesia Health System ReviewThe Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, foundations, and researchers that promotes evidence-informed Health systems policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority Health System issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries' evidence-based policy development; and builds country and regional Health systems research and evidence-informed policy HEALTHREPUBLIC PHILIPPINESOF THEOF**FLOREAT SALUBRITAS POPULIISBN-13978 92 9022 516 4iThe Republic of IndonesiaHealth System ReviewHealth Systems in Transition Vol.

2 7 No. 1 2017 Written by:Yodi Mahendradhata, Department of Public Health , Faculty of Medicine, Universitas Gadjah MadaLaksono Trisnantoro, Universitas Gadjah MadaShita Listyadewi, Center for Health Policy and Management, Universitas Gadjah MadaPrastuti Soewondo, School of Public Health , University of IndonesiaTiara Marthias, Center for Health Policy and Management, Universitas Gadjah MadaPandu Harimurti, World Bank JakartaJohn Prawira, Center for Health Policy and Management, Universitas Gadjah MadaEdited by: Krishna Hort, Nossal Institute for Global Health , University of MelbourneWalaiporn Patcharanarumol, International Health Policy Program, Ministry of Public Health ThailandAsia Pacific Observatory on Health Systems and PoliciesiiWHO Library Cataloguing-in-Publication dataWorld Health Organization, Regional Office for South-East Republic of Indonesia Health System systems in transition.

3 Vol-7, Number -11. Health Systems Plans. 2. Health Status. 3. Economics, Medical. 4. Health Care Reform. 5. Public Health . I. 978-92-9022-516-4 (NLM classification: WA ) World Health Organization 2017 (on behalf of the Asia Pacific Observatory on Health Systems and Policies)All rights for publications, or for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution can be obtained from SEARO Library, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197.)

4 E-mail: designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

5 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its views expressed in this publication are those of the authors and may not necessarily represent the decisions or policies of the World Health in IndiaiiiContentsPreface.

6 IxAcknowledgements ..xiList of abbreviations ..xiiiAbstract ..xxiiiExecutive summary ..xxivChapter 1 Introduction ..1 Chapter summary .. Geography and Economic context .. Political context .. Health status ..12 Chapter 2 Organization and governance ..18 Chapter summary .. Overview of the Health System .. Historical background .. Organization .. Decentralization and centralization .. Planning .. Intersectorality .. Health information management .. Regulation .. Patient empowerment ..60 Chapter 3 Health financing ..65 Chapter summary .. Health expenditure.

7 Sources of revenue and financial flows .. Overview of the public financing schemes .. Out-of-pocket payments .. Voluntary Health insurance .. Other financing .. Payment mechanisms ..98ivChapter 4 Physical and human resources ..106 Chapter summary .. Physical resources .. Human resources ..119 Chapter 5 Provision of services ..132 Chapter summary .. Public Health .. Patient pathways .. Primary/ambulatory care .. Inpatient care .. Emergency Pharmaceutical care .. Rehabilitation/intermediate care .. Long-term care .. Services for informal carers .. Palliative care.

8 Mental Health care .. Dental care .. Complementary and alternative medicine (CAM) and traditional medicine .. Health services for specific populations ..169 Chapter 6 Principal Health reforms ..170 Chapter summary .. Analysis of recent reforms .. Future developments ..200 Chapter 7 Assessment of the Health System ..212 Chapter summary .. Stated objectives of the Health System .. Financial protection and equity in financing .. User experience and equity of access to Health care .. Health outcomes, Health service outcomes and quality of care .. Health System efficiency.

9 Transparency and accountability ..237 Chapter 8 Conclusions .. Key findings .. Lessons learnt from Health System changes .. Remaining challenges .. Future prospects ..244vChapter 9 Appendices .. References .. Further reading .. Useful web sites .. HiT methodology and production process .. About the authors ..291 List of FiguresFigure Population of Indonesia , 2010 (left) and projected for 2030 (right) ..4 Figure Indonesia s demographic dividend ..5 Figure Selected governance indicators for Indonesia , percentile rank (1 100) ..11 Figure Burden of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of Indonesian DALYs.

10 13 Figure Organization of Health System in Indonesia , 2014 ..21 Figure Health expenditure as a share (%) of GDP in the WHO South-East Asia and Western Pacific Regions, 2014 ..68 Figure Trends in Health expenditure as a share (%) of GDP in Indonesia and selected Asian countries, 1995 2014 ..68 Figure Health expenditure in US$ PPP per capita in Indonesia and countries in the WHO South-East Asia and Western Pacific Regions, 2014 ..69 Figure Public sector Health expenditure as a share (%) of THE in Indonesia and in countries in the WHO South-East Asia and Western Pacific Regions, 2019.